Provider Demographics
NPI:1326073388
Name:STOUFFER, VANCE RUDY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:RUDY
Last Name:STOUFFER
Suffix:JR
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 1:786 CARTREF RD
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:786 CARTREF RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9640
Practice Address - Country:US
Practice Address - Phone:717-938-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010245E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0068747000OtherAMERIHEALTH 65 PA
PA011227OtherJOHNS HOPKINS
PA080176705OtherRAILROAD MEDICARE
PA000589158Medicaid
PA047575OtherHIGHMARK BLUE SHIELD
PA10226OtherGEISINGER
MD613926OtherCAREFIRST MD BCBS
PA4257548OtherAETNA
PA080176705OtherRAILROAD MEDICARE
PA0068747000OtherAMERIHEALTH 65 PA