Provider Demographics
NPI:1942230198
Name:CONSTANTINOS A. PAVLIDES, M.D., P.C.
Entity Type:Organization
Organization Name:CONSTANTINOS A. PAVLIDES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINOS
Authorized Official - Middle Name:ANDREAS
Authorized Official - Last Name:PAVLIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-568-1015
Mailing Address - Street 1:245 N BROAD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1518
Mailing Address - Country:US
Mailing Address - Phone:215-568-1015
Mailing Address - Fax:215-568-0555
Practice Address - Street 1:245 N BROAD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1518
Practice Address - Country:US
Practice Address - Phone:215-568-1015
Practice Address - Fax:215-568-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011399Medicare PIN