Healthcare Provider Details

I. General information

NPI: 1982264917
Provider Name (Legal Business Name): DANIEL JIANGDAN ZHOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BOULEVARD 2ND FLOOR, SOUTH PAVILION
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 SPRUCE ST 3 W GATES
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3606
  • Fax: 215-243-2312
Mailing address:
  • Phone: 215-662-3606
  • Fax: 215-243-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberMD482278
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: