MEDICARE: DR. ANTONIS PRATSOS 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	207RI0011X	Interventional Cardiology Physician	MD419056	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF6196	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1412018	OTHER	PA	BLUE SHIELD
3	2099070000	OTHER		KEYSTONE
4	231718130	OTHER	PA	UNITED HEALTHCARE
5	231718130	OTHER	PA	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	231718130	OTHER	PA	T RICARE

General Provider Information

NPI Number	:	1548263361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIS PRATSOS M.D.

Provider Business Mailing Address
First Line	:	1999 SPROUL RD STE 25
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-3508
Country	:	US
Telephone Number	:	610-353-6400
Fax Number	:	610-356-1204

Provider Business Practice Location Address
First Line	:	1999 SPROUL RD
Second Line	:	STE 21
City	:	BROOMALL
State	:	PA
Zip	:	19008-3508
Country	:	US
Telephone Number	:	610-353-6400
Fax Number	:	610-356-1204

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/09/2019

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Directions to “ DR. ANTONIS PRATSOS M.D.” Practice Location

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