Provider Demographics
NPI:1790179299
Name:PAPATHOMAS, KONSTANTINA (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTINA
Middle Name:
Last Name:PAPATHOMAS
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 1:1020 SANSOM ST
Mailing Address - Street 2:SUITE 1651 B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5002
Mailing Address - Country:US
Mailing Address - Phone:215-955-9837
Mailing Address - Fax:215-955-9870
Practice Address - Street 1:1020 SANSOM ST
Practice Address - Street 2:SUITE 1651 B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5002
Practice Address - Country:US
Practice Address - Phone:215-955-9837
Practice Address - Fax:215-955-9870
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA1037800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program