Provider Demographics
NPI:1306848304
Name:DERSHAW, STUART Z (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:Z
Last Name:DERSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:STE 4
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1338
Mailing Address - Country:US
Mailing Address - Phone:215-914-4400
Mailing Address - Fax:215-657-4887
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1338
Practice Address - Country:US
Practice Address - Phone:215-914-4400
Practice Address - Fax:215-657-4887
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAM0016967E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007299380001Medicaid
C27871Medicare UPIN
PA027635L5JMedicare PIN