Despina Tsirakoglou, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS-007639L Issued in PA

Practice address

300 Pheasant Lane
Newtown Square, PA 19073

Phone

(610) 570-9532

Fax

(610) 325-0828

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1811950793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PHEASANT LANE",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "19073",
            "telephone_number": "610-570-9532",
            "fax_number": "610-325-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PHEASANT LANE",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "19073",
            "telephone_number": "610-570-9532",
            "fax_number": "610-325-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSIRAKOGLOU",
        "first_name": "DESPINA",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS-007639L",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS-007639-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001431139001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Newtown Square, PA
• Providers in Newtown Square, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.