Provider Demographics
NPI:1548208655
Name:OLIN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:OLIN
Suffix:
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015380E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000544147 0006Medicaid
PAB37897OtherAMERIHEALTH ADMINISTRATORS
PAP002503OtherGATEWAY
PA100338COtherMERCY
PA35538OtherGEISINGER HEALTH PLAN
PA080100809OtherRR MEDICARE
PA30008213OtherKEYSTONE MERCY
PA5107361OtherAETNA-NON HMO
PA000000257192OtherUNISON
PA0038482000OtherINDEPENDENCE BLUE CROSS
PA50082751OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA000133030OtherHIGHMARK
PA0038482000OtherINDEPENDENCE BLUE CROSS
PA35538OtherGEISINGER HEALTH PLAN