Provider Demographics
NPI:1144240243
Name:ZAVITSANOS, THOMAS P (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:ZAVITSANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 304
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-612-4060
Practice Address - Fax:215-612-2630
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041904E207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012020000002Medicaid
PA810454462OtherPHCS
PA0012020000005Medicaid
PA0012020000001Medicaid
PA0012020000006Medicaid
PA30002953OtherKEYSTONE MERCY
PA605367OtherHIGHMARK BLUE SHIELD
PA050090775OtherRAILROAD MEDICARE
PA1134679OtherCIGNA
PA3056444OtherAETNA CONTRACT
PA30070979OtherKEYSTONE MERCY - PM
PA605367OtherPERSONAL CHOICE
PA01202000-05OtherAMERICHOICE
PA0427892000OtherKEYSTONE IBC
PA1330666OtherFIRST HEALTH
PA1242712OtherUNITED HEALTHCARE
PA0427892000OtherKEYSTONE IBC
PA1134679OtherCIGNA