MEDICARE: SAVOPOULOS PROFESSIONAL, LLC

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	207Q00000X	Family Medicine Physician	D42464	MD

General Provider Information

NPI Number	:	1396780094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVOPOULOS PROFESSIONAL, LLC

Provider Business Mailing Address
First Line	:	255 N 4TH ST
Second Line	:	SUITE 1
City	:	OAKLAND
State	:	MD
Zip	:	21550-1375
Country	:	US
Telephone Number	:	301-533-1046
Fax Number	:	301-533-1049

Provider Business Practice Location Address
First Line	:	255 N 4TH ST
Second Line	:	SUITE 1
City	:	OAKLAND
State	:	MD
Zip	:	21550-1375
Country	:	US
Telephone Number	:	301-533-1046
Fax Number	:	301-533-1049

Authorized Official
Title or Position	:	OWNER
Name	:	SOTIERE SAVOPOULOS
Credential	:	M.D.
Telephone Number	:	301-533-1046

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	06/13/2008

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Directions to “SAVOPOULOS PROFESSIONAL, LLC ” Practice Location

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