Provider Demographics
NPI:1164423364
Name:STIEBEL, VICTOR GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:GORDON
Last Name:STIEBEL
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 1:6350 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1808
Mailing Address - Country:US
Mailing Address - Phone:412-521-8521
Mailing Address - Fax:
Practice Address - Street 1:6350 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1808
Practice Address - Country:US
Practice Address - Phone:412-521-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA047958L2084P0800X
PAMD047957L207P00000X
TXQ05742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001399407027Medicaid
PA0013994070022Medicaid
PA100232OtherUPMC
PA265145OtherBLUE SHIELD
PA930129117Medicare PIN
PAD81320Medicare UPIN
PA0001399407027Medicaid
PA0013994070022Medicaid
PA411983GXFMedicare PIN