Individual
MISS THANA THEOFANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
909 WALNUT ST, COB 3RD FLOOR, PHILADELPHIA, PA 19107-5211
(215) 955-7008
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
(484) 337-1530
(484) 337-1412
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD473556
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2014
Last updated
06/24/2021
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