Provider Demographics
NPI:1700031812
Name:STEFAN L. STANESCU, MD, PA
Entity Type:Organization
Organization Name:STEFAN L. STANESCU, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:LUCIAN
Authorized Official - Last Name:STANESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-797-2663
Mailing Address - Street 1:PO BOX 9018
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-9018
Mailing Address - Country:US
Mailing Address - Phone:904-797-2663
Mailing Address - Fax:904-819-0997
Practice Address - Street 1:105 SOUTHPARK BLVD STE C300
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-797-2663
Practice Address - Fax:904-819-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076144207X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5341930001Medicare NSC
FL43694Medicare PIN
FLG74685Medicare UPIN