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NPI Code Detail

MEDICARE: MR. THEODORE ANASTASIOS PANTARIDIS PA-C

MEDICARE: MR. THEODORE ANASTASIOS PANTARIDIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA9103667FL

General Provider Information

NPI Number : 1376783548
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THEODORE ANASTASIOS PANTARIDIS PA-C
Provider Business Mailing Address
First Line : 12067 BASIN ST W
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-5754
Country : US
Telephone Number : 561-639-9580
Fax Number :
Provider Business Practice Location Address
First Line : 5818 S DIXIE HWY
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33405-3608
Country : US
Telephone Number : 561-429-4779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2009
Last Update Date : 12/05/2023

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