Healthcare Provider Details

I. General information

NPI: 1730552514
Provider Name (Legal Business Name): DANIELA PANTELOGLOUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA
APO AE
09112
US

IV. Provider business mailing address

USA MEDDAC BAVARIA MMR 411 BLDG 700
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3886
  • Fax:
Mailing address:
  • Phone: 0637194643886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002083526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: