Provider Demographics
NPI:1255305819
Name:STEFANIK, DAVID F (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:STEFANIK
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 1:337 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2541
Mailing Address - Country:US
Mailing Address - Phone:814-534-4724
Mailing Address - Fax:814-536-5135
Practice Address - Street 1:337 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2541
Practice Address - Country:US
Practice Address - Phone:814-534-4724
Practice Address - Fax:814-536-5135
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020857E2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000753675Medicaid
PA000753675Medicaid
PA453342Medicare ID - Type Unspecified