Provider Demographics
NPI:1760456826
Name:PAVLOU, BILL J (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:J
Last Name:PAVLOU
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 1:901 W. ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036
Mailing Address - Country:US
Mailing Address - Phone:484-494-5604
Mailing Address - Fax:610-461-7423
Practice Address - Street 1:901 W. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036
Practice Address - Country:US
Practice Address - Phone:484-494-5604
Practice Address - Fax:610-461-7423
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045093L207Q00000X
NY161227-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039765OtherPA MEDICARE GROUP
NY00901524Medicaid
PAGU039765OtherPA MEDICARE GROUP
NY00901524Medicaid
619899N8FMedicare PIN
PA619899YDMTMedicare PIN