Provider Demographics
NPI:1538362298
Name:KARAMITOPOULOS, MARA SELENE (MD)
Entity type:Individual
Prefix:DR
First Name:MARA
Middle Name:SELENE
Last Name:KARAMITOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1600 ARCH ST APT 1011
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2009
Mailing Address - Country:US
Mailing Address - Phone:215-313-6434
Mailing Address - Fax:
Practice Address - Street 1:1015 WALNUT ST
Practice Address - Street 2:SUITE 801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-977-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT186052207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT186052OtherMEDICAL TRAINING LICENSE