Active NPI
Constantine Mavroudis, M.D.
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Orlando, FL
National Provider Identifier
1952396897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- License
- ME112169
- Practice address
- 2501 N. Orange Ave
Suite 450
Orlando, FL 32804 - Phone
- (407) 303-3692
- Fax
- (407) 303-3634
- NPI assigned
- Sep 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 35-092453 | OH | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | ME112169 | FL | Primary |
Addresses
Primary practice location
2501 N. Orange Ave
Suite 450
Orlando, FL 32804
Mailing address
2501 N. Orange Ave
Suite 450
Orlando, FL 32804
Phone (407) 303-3692
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| XPY198252 | Medicaid | CA | |
| 004570600 | Medicaid | FL | |
| 1627123 | Other | IL | BCBS PROVIDER ID |
| 64213531 | Medicaid | KY | |
| 036079315 | Medicaid | IL | |
| 2865896 | Medicaid | OH | |
| CSF715 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35-092453 | OH | MD | Pediatric Surgery Physician |
| ME112169 | FL | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1952396897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 N. ORANGE AVE",
"address_2": "SUITE 450",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32804",
"telephone_number": "407-303-3692",
"fax_number": "407-303-3634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 N. ORANGE AVE",
"address_2": "SUITE 450",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32804",
"telephone_number": "407-303-3692",
"fax_number": "407-303-3634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAVROUDIS",
"first_name": "CONSTANTINE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-16",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "OH",
"license": "35-092453",
"primary": false
},
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "FL",
"license": "ME112169",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "XPY198252",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004570600",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER ID",
"identifier": "1627123",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64213531",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036079315",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2865896",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CSF715",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.