MEDICARE: DR. DIMITRIOS PAPAVASSILIOU M.D.

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
1	2080P0202X	Pediatric Cardiology Physician	234741	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386615250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMITRIOS PAPAVASSILIOU M.D.

Provider Business Mailing Address
First Line	:	3415 BAINBRIDGE AVE
Second Line	:	ROSENTHAL 1
City	:	BRONX
State	:	NY
Zip	:	10467-2403
Country	:	US
Telephone Number	:	718-741-2343
Fax Number	:	718-920-4351

Provider Business Practice Location Address
First Line	:	3415 BAINBRIDGE AVE
Second Line	:	ROSENTHAL 1
City	:	BRONX
State	:	NY
Zip	:	10467-2403
Country	:	US
Telephone Number	:	718-741-2343
Fax Number	:	718-920-4351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	12/11/2016

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