Provider Demographics
NPI:1184753964
Name:MAVROS, STEVEN (LOM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MAVROS
Suffix:
Gender:M
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHESTNUT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3059
Mailing Address - Country:US
Mailing Address - Phone:215-627-3782
Mailing Address - Fax:
Practice Address - Street 1:123 CHESTNUT ST
Practice Address - Street 2:STE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3059
Practice Address - Country:US
Practice Address - Phone:215-627-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist