Provider Demographics
NPI:1801853015
Name:PSARROS, STAMATIOS (THOMAS) G (MD)
Entity Type:Individual
Prefix:
First Name:STAMATIOS (THOMAS)
Middle Name:G
Last Name:PSARROS
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 1:601 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1496
Mailing Address - Country:US
Mailing Address - Phone:610-375-4567
Mailing Address - Fax:610-685-8801
Practice Address - Street 1:601 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-375-4567
Practice Address - Fax:610-685-8801
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50056917OtherCAPITAL BLUE CROSS
PA116567600OtherUS DEPT OF LABOR
PAPS1818299OtherHIGHMARK BLUE SHIELD
PA098830R1XOtherMEDICARE ID
PA50056917OtherCAPITAL BLUE CROSS