Provider Demographics
NPI:1235249913
Name:STEPANOW, SAMUEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:J
Last Name:STEPANOW
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 1:213 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-772-9797
Mailing Address - Fax:724-772-3309
Practice Address - Street 1:213 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-772-9797
Practice Address - Fax:724-772-3309
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036308E207R00000X
NJ25MA04886000207R00000X
FLME92867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115037OtherKEYSTONE HIGHMARK
C30543Medicare UPIN
115037Medicare ID - Type Unspecified