Basic Information
| Provider Information | |||||||||
| NPI: | 1730349176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAPANAGNOU | ||||||||
| FirstName: | DIMITRIOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | SUITE 239 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | SUITE 239 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 390200000S | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | MD450140 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0391832 | 05 | NJ | MEDICAID | 102888810 | 05 | PA | MEDICAID |