=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629286018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STAVROPOULA IOANNIS TJOUMAKARIS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 05/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 WALNUT STREET, 2RD FLOOR JEFFERSON NEUROSURGICAL ASSOCIATES
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7000
-----------------------------------------------------
Fax | 215-503-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 WALNUT ST 2ND FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7000
-----------------------------------------------------
Fax | 215-503-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | MD434545
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 25MA08528700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------