Provider Demographics
NPI:1578581864
Name:EWING, STEPHANIE H (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:H
Last Name:EWING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2614
Mailing Address - Country:US
Mailing Address - Phone:215-829-8000
Mailing Address - Fax:215-829-3701
Practice Address - Street 1:700 SPRUCE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4022
Practice Address - Country:US
Practice Address - Phone:215-829-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056899207V00000X
PAMD056899L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001642975Medicaid
PAG20750Medicare UPIN
PA640850Medicare PIN