Provider Demographics
NPI:1225099120
Name:ANASTASOPOULOU, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ANASTASOPOULOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE G01 MAB
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2249
Mailing Address - Country:US
Mailing Address - Phone:215-572-5200
Mailing Address - Fax:215-572-6456
Practice Address - Street 1:50 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE G01 MAB
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2249
Practice Address - Country:US
Practice Address - Phone:215-572-5200
Practice Address - Fax:215-572-6456
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-071321-L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019221730004Medicaid
PA050542Medicare PIN
PA0019221730004Medicaid