Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD063694L | PA |
NPI | 1013912070 |
---|---|
Provider Name | Savas Mavridis |
First Address | York, PA 17402-9001 |
Second Address | Lebanon, PA 17042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019548830001 | (05) | PA |
H61775 | (02) |