Provider Demographics
NPI:1629056296
Name:MILBACK, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MILBACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:757 NORLAND AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4230
Practice Address - Country:US
Practice Address - Phone:717-217-6760
Practice Address - Fax:717-217-6702
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA68585207Q00000X
PAMD431227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710048OtherAETNA HMO
PA25-1716306OtherFIRST HEALTH
PAMD431227OtherLICENSE
PA25-1716306OtherINTERGROUP
PA2169007OtherMAMSI
PA9563094OtherAETNA NON-HMO
PAP00421647OtherRAILROAD MEDICARE
PA102027294 0001Medicaid
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherGREATWEST HEALTHCARE
PA120420409OtherDEPT OF LABOR
PA25-1716306OtherINFORMED
PA25-1716306OtherDEVON
PAU811-0009OtherCAREFIRST DC
PA1007307260034OtherMEDICAID GROUP #
PA25-1716306OtherHEALTHNET/TRICARE
PA913162-01OtherCAREFIRST MD
PAP009306OtherGATEWAY
PA0018878330001Medicaid
PA1831119221OtherCAPITAL BLUECROSS
PA728028OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PAMI985611OtherHIGHMARK BLUESHIELD
PA225564OtherUNISON
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAFM0293807OtherDEA