Healthcare Provider Details

I. General information

NPI: 1174015911
Provider Name (Legal Business Name): CONSTANTINE DEMETRIOS TROUPES MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD BLDG SUITE404
PHILADELPHIA PA
19141-3030
US

IV. Provider business mailing address

3401 N BROAD ST FL 4
PHILADELPHIA PA
19140-5103
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD482244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: