Provider Demographics
NPI:1235192741
Name:DAVIDES, KYRIAKOS CONSTANTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYRIAKOS
Middle Name:CONSTANTIN
Last Name:DAVIDES
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 1:1402 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-1606
Mailing Address - Country:US
Mailing Address - Phone:412-673-8429
Mailing Address - Fax:412-673-8430
Practice Address - Street 1:1402 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1606
Practice Address - Country:US
Practice Address - Phone:412-673-8429
Practice Address - Fax:412-673-8430
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032621L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0686400Medicaid
PAB33938Medicare UPIN
PADA33033Medicare ID - Type Unspecified