Healthcare Provider Details

I. General information

NPI: 1144240243
Provider Name (Legal Business Name): THOMAS P. ZAVITSANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 304
PHILADELPHIA PA
19114-1445
US

IV. Provider business mailing address

PO BOX 8500-6335
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4060
  • Fax: 215-612-2630
Mailing address:
  • Phone: 215-807-8000
  • Fax: 215-807-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD041904E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD041904E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: