Provider Demographics
NPI:1548263361
Name:PRATSOS, ANTONIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIS
Middle Name:
Last Name:PRATSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 SPROUL RD STE 25
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:610-356-1204
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:610-356-1204
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419056207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACF6196OtherRAILROAD MEDICARE
PA1412018OtherBLUE SHIELD
2099070000OtherKEYSTONE
PA231718130OtherUNITED HEALTHCARE
PA231718130OtherCIGNA
PA0019212830001Medicaid
PA231718130OtherT RICARE