Provider Demographics
NPI:1629229026
Name:STEFANOWICZ, LOIS VERONICA (DO)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:VERONICA
Last Name:STEFANOWICZ
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 1:7504 MANTI ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4130
Mailing Address - Country:US
Mailing Address - Phone:267-939-7504
Mailing Address - Fax:
Practice Address - Street 1:7504 MANTI ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4130
Practice Address - Country:US
Practice Address - Phone:267-939-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004770L208600000X
CA20A6206208600000X
PAKO000087L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00719Medicare UPIN