MEDICARE: DR. TASOS ASLANIDIS D.O.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	MB06162400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139675KD4	OTHER	PA	PTAN
2	901189SBS	OTHER	NJ	PTAN

General Provider Information

NPI Number	:	1568438703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TASOS ASLANIDIS D.O.

Provider Business Mailing Address
First Line	:	1841 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2115
Country	:	US
Telephone Number	:	215-465-8800
Fax Number	:	215-465-8814

Provider Business Practice Location Address
First Line	:	1841 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2115
Country	:	US
Telephone Number	:	215-465-8800
Fax Number	:	215-465-8814

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	03/25/2015

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