Provider Demographics
NPI:1750327375
Name:HOSMER, STEPHAN B (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:B
Last Name:HOSMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WHITE HORSE RD
Mailing Address - Street 2:#502
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4406
Mailing Address - Country:US
Mailing Address - Phone:856-627-9898
Mailing Address - Fax:856-627-7647
Practice Address - Street 1:1000 WHITE HORSE RD
Practice Address - Street 2:#502
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:856-627-9898
Practice Address - Fax:856-627-7647
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04305900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3726506Medicaid
NJST015946Medicare ID - Type Unspecified
NJ3726506Medicaid