Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD458878 | PA |
NPI | 1124200167 |
---|---|
Provider Name | Charles Tanos Bakhos |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2007 |
Last Update Date | 18/06/2018 |