Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD467163 | PA |
NPI | 1750776225 |
---|---|
Provider Name | Theodore George Drivas |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 15/07/2019 |