Healthcare Provider Details

I. General information

NPI: 1720095797
Provider Name (Legal Business Name): THEOKLIS E ZAOUTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILA - DIV OF INFECTIOUS DISEAS
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR NORTH TOWER
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2017
  • Fax: 215-590-2025
Mailing address:
  • Phone: 267-425-9232
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD066940L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD066940L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: