MEDICARE: DR. BILL J PAVLOU MD

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	MD045093L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GU039765	OTHER	PA	PA MEDICARE GROUP

Other Identifiers

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

General Provider Information

NPI Number	:	1760456826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILL J PAVLOU MD

Provider Business Mailing Address
First Line	:	901 W. ASHLAND AVE.
Second Line	:
City	:	GLENOLDEN
State	:	PA
Zip	:	19036
Country	:	US
Telephone Number	:	484-494-5604
Fax Number	:	610-461-7423

Provider Business Practice Location Address
First Line	:	901 W. ASHLAND AVE.
Second Line	:
City	:	GLENOLDEN
State	:	PA
Zip	:	19036
Country	:	US
Telephone Number	:	484-494-5604
Fax Number	:	610-461-7423

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	12/29/2015

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