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General NPI Number Information
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NPI Number | 1841242823
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Entity Type | Organization
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Legal Business Name | CHARLES S. THEOFILOS MD PA
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 300 VILLAGE SQUARE XING STE 202
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3223
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Country | US
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Telephone | 561-630-3870
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Fax | 561-630-3680
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Provider Business Mailing Address
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Address Line | 300 VILLAGE SQUARE XING STE 202
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3223
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Country | US
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Telephone | 561-630-3870
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Fax | 561-630-3680
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | CHARLES S THEOFILOS
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Credential |
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Telephone | 561-630-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | XXXXXXXXXXXXXXXX
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License Number State | FL
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