1659396315 NPI number — DR. VASILIOS N SPYROPOULOS DPM

Table of content: DR. VASILIOS N SPYROPOULOS DPM (NPI 1659396315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659396315 NPI number — DR. VASILIOS N SPYROPOULOS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPYROPOULOS
Provider First Name:
VASILIOS
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659396315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 OLD NATIONAL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15333-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-632-6801
Provider Business Mailing Address Fax Number:
724-632-6312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-223-1067
Provider Business Practice Location Address Fax Number:
724-223-1088
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO4284 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 07001165A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 36.003692 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0159318 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201202870 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114265200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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