Healthcare Provider Details

I. General information

NPI: 1144225905
Provider Name (Legal Business Name): THOMAS PHIAMBOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE JD LANKENAU PAVILION, MEZZANINE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-1000
  • Fax: 484-476-9000
Mailing address:
  • Phone: 484-476-1000
  • Fax: 484-476-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD023914E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: