Healthcare Provider Details

I. General information

NPI: 1679558498
Provider Name (Legal Business Name): BASIL KARAYANNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

708 SOUTHWINDS DR
BRYN MAWR PA
19010-2043
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3714
  • Fax: 215-728-3923
Mailing address:
  • Phone: 215-728-3714
  • Fax: 215-728-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD039891L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD039891L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: