Provider Demographics
NPI:1588771513
Name:VLAHOS, THEODORE P (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:P
Last Name:VLAHOS
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 1:31581 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3724
Mailing Address - Country:US
Mailing Address - Phone:727-772-0819
Mailing Address - Fax:727-772-8430
Practice Address - Street 1:31581 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3724
Practice Address - Country:US
Practice Address - Phone:727-772-0819
Practice Address - Fax:727-772-8430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4401790001Medicare NSC
FLG60063Medicare UPIN
FLK3540Medicare PIN