Provider Demographics
NPI:1598732547
Name:BLONDEK, STANLEY W (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:W
Last Name:BLONDEK
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 1:247 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1641
Mailing Address - Country:US
Mailing Address - Phone:570-382-3665
Mailing Address - Fax:570-483-4137
Practice Address - Street 1:247 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-382-3665
Practice Address - Fax:570-483-4137
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040153L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001179637Medicaid
PA001179637Medicaid