Provider Demographics
NPI:1689667065
Name:DEPMAN, STANLEY T (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:T
Last Name:DEPMAN
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 1:3542 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2623
Mailing Address - Country:US
Mailing Address - Phone:215-333-6888
Mailing Address - Fax:215-333-3945
Practice Address - Street 1:3542 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2623
Practice Address - Country:US
Practice Address - Phone:215-333-6888
Practice Address - Fax:215-333-3945
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033216E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2676083OtherOXFORD
PA0058417000OtherKEYSTONE
PA081201OtherBLUE SHIELD
PA5829300OtherAETNA
PA0058417000OtherPERSONAL CHOICE
PA0163653904OtherAMERICHOICE
PA081201OtherIBC
PA1066839OtherKEYSTONE MERCY
PA01011636539Medicaid
PA080162557OtherRR MEDICARE
PA5829300OtherAETNA
PA081201OtherBLUE SHIELD