Provider Demographics
NPI:1093033557
Name:STAVROPOULOS, LATA TADIKONDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:TADIKONDA
Last Name:STAVROPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LATA
Other - Middle Name:
Other - Last Name:TADIKONDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:707 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2082
Mailing Address - Country:US
Mailing Address - Phone:610-527-9676
Mailing Address - Fax:
Practice Address - Street 1:707 STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2082
Practice Address - Country:US
Practice Address - Phone:610-527-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071099L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine