Basic Information
| Provider Information | |||||||||
| NPI: | 1366800823 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENRY P SIDEROPOULOS MD INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HENRY P SIDEROPOULOS MD INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1771 E ORANGE GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911040000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9099416974 | ||||||||
| Practice Location | |||||||||
| Address1: | 1771 E ORANGE GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911040000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264848947 | ||||||||
| FaxNumber: | 6266280492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | SIDEROPOULOS | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 9094842865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G42050 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.