MEDICARE: DR. CHARLES S THEOFILOS M.D. P.A.

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	207T00000X	Neurological Surgery Physician	ME0064328	FL

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	:	1861444846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES S THEOFILOS M.D. P.A.

Provider Business Mailing Address
First Line	:	300 VILLAGE SQUARE XING STE 202
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3223
Country	:	US
Telephone Number	:	561-630-3870
Fax Number	:	561-630-3680

Provider Business Practice Location Address
First Line	:	300 VILLAGE SQUARE XING STE 202
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3223
Country	:	US
Telephone Number	:	561-630-3870
Fax Number	:	561-630-3680

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/18/2021

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