Provider Demographics
NPI:1699841551
Name:STAKE, ROBERT ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERIC
Last Name:STAKE
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 1:385 WEST LANCASTER AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1551
Mailing Address - Country:US
Mailing Address - Phone:610-645-0976
Mailing Address - Fax:
Practice Address - Street 1:385 WEST LANCASTER AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1551
Practice Address - Country:US
Practice Address - Phone:610-645-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020855E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D68780Medicare UPIN
ST107372Medicare ID - Type Unspecified