Provider Demographics
NPI:1023078391
Name:CHRISTOFORATOS, DEMETRIUS (MD)
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:CHRISTOFORATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEMETRANGELOS
Other - Middle Name:
Other - Last Name:CHRISTOFORATOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1110 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-2001
Mailing Address - Country:US
Mailing Address - Phone:570-346-7797
Mailing Address - Fax:770-666-9078
Practice Address - Street 1:1110 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-2001
Practice Address - Country:US
Practice Address - Phone:570-346-7797
Practice Address - Fax:770-666-9078
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036318L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00639175OtherRR MEDICARE
PA0010156520018Medicaid
PA411033F4NMedicare PIN
PA0010156520018Medicaid