Healthcare Provider Details

I. General information

NPI: 1508862806
Provider Name (Legal Business Name): PRODROMOS A VERVERELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ELK CHASE CT
TAYLORSVILLE KY
40071-7260
US

IV. Provider business mailing address

400 ELK CHASE CT
TAYLORSVILLE KY
40071-7260
US

V. Phone/Fax

Practice location:
  • Phone: 610-390-8228
  • Fax:
Mailing address:
  • Phone: 610-390-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD044774L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number55069
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: