Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA09156100 | NJ |
Y | 207Q00000X | Family Doctor | 61178 | SC |
N | 207Q00000X | Family Doctor | MT196080 | PA |
NPI | 1003046889 |
---|---|
Provider Name | Ms. Vasiliki Papathanasiou |
First Address | Myrtle Beach, SC 29579-4477 |
Second Address | Myrtle Beach, SC 29579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 15/02/2021 |