Healthcare Provider Details

I. General information

NPI: 1760456826
Provider Name (Legal Business Name): BILL J PAVLOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W. ASHLAND AVE.
GLENOLDEN PA
19036
US

IV. Provider business mailing address

901 W. ASHLAND AVE.
GLENOLDEN PA
19036
US

V. Phone/Fax

Practice location:
  • Phone: 484-494-5604
  • Fax: 610-461-7423
Mailing address:
  • Phone: 484-494-5604
  • Fax: 610-461-7423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD045093L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: