Provider Demographics
NPI:1114064417
Name:PAPOUTSIS, DEAN V (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:V
Last Name:PAPOUTSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOLME AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-4944
Mailing Address - Fax:215-331-3619
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-4944
Practice Address - Fax:215-331-3619
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046468L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG03847Medicare UPIN