Provider Demographics
NPI:1912926908
Name:THEOFANIDIS, STYLIANOS NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STYLIANOS
Middle Name:NICHOLAS
Last Name:THEOFANIDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-0673
Mailing Address - Country:US
Mailing Address - Phone:203-863-3515
Mailing Address - Fax:203-863-3816
Practice Address - Street 1:5 PERRYRIDGE ROAD
Practice Address - Street 2:GREENWICH HOSPITAL
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4697
Practice Address - Country:US
Practice Address - Phone:203-863-3515
Practice Address - Fax:203-863-3816
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT028038208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine