Healthcare Provider Details

I. General information

NPI: 1932171220
Provider Name (Legal Business Name): TRICIA V PAVLOPOULOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 142
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

PO BOX 411607
SAINT LOUIS MO
63141-3607
US

V. Phone/Fax

Practice location:
  • Phone: 314-924-3924
  • Fax: 314-548-2255
Mailing address:
  • Phone: 314-432-1047
  • Fax: 314-569-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number106145
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: