Provider Demographics
NPI:1497850176
Name:TIMOTHY S STANTON MD
Entity Type:Organization
Organization Name:TIMOTHY S STANTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-723-8240
Mailing Address - Street 1:114 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365
Mailing Address - Country:US
Mailing Address - Phone:814-723-8240
Mailing Address - Fax:814-723-3665
Practice Address - Street 1:114 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365
Practice Address - Country:US
Practice Address - Phone:814-723-8240
Practice Address - Fax:814-723-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA153655207R00000X
PAMA003301L363AM0700X
PAMA002037L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00165061OtherRAILROAD MEDICAL
1568169OtherBLUE CROSS BS GROUP #
158813OtherTHREE RIVERS
PA0557234Medicaid
303396OtherUPMC
DC3811OtherRAILROAD MEDICAL GR #
755356OtherBLUE CROSS BS
755356TCEMedicare ID - Type Unspecified
1568169OtherBLUE CROSS BS GROUP #
303396OtherUPMC