Healthcare Provider Details

I. General information

NPI: 1629286018
Provider Name (Legal Business Name): STAVROPOULA IOANNIS TJOUMAKARIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT STREET, 2RD FLOOR JEFFERSON NEUROSURGICAL ASSOCIATES
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

909 WALNUT ST 2ND FLOOR
PHILADELPHIA PA
19107-5211
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7000
  • Fax: 215-503-7007
Mailing address:
  • Phone: 215-955-7000
  • Fax: 215-503-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD434545
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA08528700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: