Provider Demographics
NPI:1508805904
Name:PAVLIDES, ANNA C (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:PAVLIDES
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 1:2 TELEPORT DR STE 207
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10311-1004
Mailing Address - Country:US
Mailing Address - Phone:718-273-5500
Mailing Address - Fax:718-273-3232
Practice Address - Street 1:2 TELEPORT DR STE 207
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10311-1004
Practice Address - Country:US
Practice Address - Phone:718-273-5500
Practice Address - Fax:718-273-3232
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53G661Medicare PIN
NYG81500Medicare UPIN