Provider Demographics
NPI:1255322798
Name:LEBOUITZ, STANTON S (MD)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:S
Last Name:LEBOUITZ
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 1:1936 POWDER MILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4725
Mailing Address - Country:US
Mailing Address - Phone:717-741-0811
Mailing Address - Fax:717-741-9499
Practice Address - Street 1:1936 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4725
Practice Address - Country:US
Practice Address - Phone:717-741-0811
Practice Address - Fax:717-741-9499
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011092E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006181700002Medicaid
PAB34645Medicare UPIN
PA062987Medicare ID - Type Unspecified