Provider Demographics
NPI:1659385870
Name:STEVENS, JOHN S JR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:STEVENS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 N BROOKSIDE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9652
Mailing Address - Country:US
Mailing Address - Phone:610-398-1177
Mailing Address - Fax:610-395-5419
Practice Address - Street 1:682 N BROOKSIDE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9652
Practice Address - Country:US
Practice Address - Phone:610-398-1177
Practice Address - Fax:610-395-5419
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003169L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000703280Medicaid
PA024385Medicare ID - Type Unspecified
PAD77441Medicare UPIN