Provider Demographics
NPI:1780319327
Name:DE FREITAS SIMPLICIO ANANIAS, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DE FREITAS SIMPLICIO ANANIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 OLD YORK RD FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2985
Mailing Address - Country:US
Mailing Address - Phone:215-394-4195
Mailing Address - Fax:215-457-4261
Practice Address - Street 1:5201 OLD YORK RD FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2985
Practice Address - Country:US
Practice Address - Phone:215-394-4195
Practice Address - Fax:215-457-4261
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT227340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine