Provider Demographics
NPI:1891726006
Name:PAVLIDES, NIKOS KONSTANTINOS (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOS
Middle Name:KONSTANTINOS
Last Name:PAVLIDES
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 1:1561 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3218
Mailing Address - Country:US
Mailing Address - Phone:610-792-9292
Mailing Address - Fax:610-792-9292
Practice Address - Street 1:1561 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3218
Practice Address - Country:US
Practice Address - Phone:610-792-9292
Practice Address - Fax:610-792-9292
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA430394207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I57204Medicare UPIN