Healthcare Provider Details

I. General information

NPI: 1063737682
Provider Name (Legal Business Name): JOHN C MAVROPOULOS M.D., M.P.H., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S HIAWASSEE RD APT 4601
ORLANDO FL
32835-8768
US

IV. Provider business mailing address

2121 S HIAWASSEE RD APT 4601
ORLANDO FL
32835-8768
US

V. Phone/Fax

Practice location:
  • Phone: 443-435-3517
  • Fax:
Mailing address:
  • Phone: 443-435-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME 124728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: