Provider Demographics
NPI:1629043831
Name:STAPLETON, DWIGHT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:DAVID
Last Name:STAPLETON
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417062207RC0000X
NY222968-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018636900001Medicaid
NY02189504Medicaid
NYP00327245OtherRR MEDICARE PIN
PAGU039823OtherPA MEDICARE GROUP
NYCC8362OtherRR MEDICARE GROUP
PA060066509OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
NY02189504Medicaid
PA0018636900001Medicaid
PAGU039823OtherPA MEDICARE GROUP