Provider Demographics
NPI:1558338897
Name:STEFANILE, LUKE ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ADAM
Last Name:STEFANILE
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3100
Practice Address - Country:US
Practice Address - Phone:570-321-2850
Practice Address - Fax:570-321-2851
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421458207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019737080001Medicaid
PA817860OtherFIRST PRIORITY HEALTH
PA7272477OtherAETNA
PA1512005OtherHIGHMARK BLUE SHIELD
PA2519049OtherUNITEDHEALTHCARE
PAH91704OtherHEALTHAMERICA
PAH91704OtherHEALTHAMERICA
PA2519049OtherUNITEDHEALTHCARE
PA0019737080001Medicaid