Provider Demographics
NPI:1508850488
Name:PANCOAST, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:PANCOAST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:743 JEFFERSON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1636
Mailing Address - Country:US
Mailing Address - Phone:570-342-5253
Mailing Address - Fax:570-342-6038
Practice Address - Street 1:743 JEFFERSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1636
Practice Address - Country:US
Practice Address - Phone:570-342-5253
Practice Address - Fax:570-342-6038
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 0022176E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000727844Medicaid
PA000727844Medicaid
PA098979Medicare PIN