Provider Demographics
NPI:1588670285
Name:STAINBROOK, TUESDAE (DO)
Entity Type:Individual
Prefix:DR
First Name:TUESDAE
Middle Name:
Last Name:STAINBROOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MIDWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3857
Mailing Address - Country:US
Mailing Address - Phone:814-371-2348
Mailing Address - Fax:
Practice Address - Street 1:135 MIDWAY DR STE B
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3857
Practice Address - Country:US
Practice Address - Phone:814-371-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009811-L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001707096Medicaid
PAG79000Medicare UPIN
PA001707096Medicaid