Provider Demographics
NPI:1003013699
Name:STEPHEN C CENEDELLA, PC
Entity Type:Organization
Organization Name:STEPHEN C CENEDELLA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CENEDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-432-4744
Mailing Address - Street 1:150 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2542
Mailing Address - Country:US
Mailing Address - Phone:814-432-4744
Mailing Address - Fax:814-432-8648
Practice Address - Street 1:150 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2542
Practice Address - Country:US
Practice Address - Phone:814-432-4744
Practice Address - Fax:814-432-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013634E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007292950001Medicaid
PA0017006670001Medicaid
PAF92157Medicare UPIN
PAB39565Medicare UPIN