Provider Demographics
NPI:1447228986
Name:STEPHEN, PRIYA C (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:C
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRIYA
Other - Middle Name:C
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:104 PHEASANT RUN STE 116B
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3414
Mailing Address - Country:US
Mailing Address - Phone:215-968-6844
Mailing Address - Fax:215-968-4519
Practice Address - Street 1:104 PHEASANT RUN STE 116B
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3414
Practice Address - Country:US
Practice Address - Phone:215-968-6844
Practice Address - Fax:215-968-4519
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08046500208000000X
PAMD427789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH95567Medicare UPIN