Provider Demographics
NPI:1780681262
Name:SHOEMAKER, STEPHEN N (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:N
Last Name:SHOEMAKER
Suffix:
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 1:217 E 9TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-3305
Mailing Address - Country:US
Mailing Address - Phone:570-453-2555
Mailing Address - Fax:570-453-1043
Practice Address - Street 1:217 E 9TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-3305
Practice Address - Country:US
Practice Address - Phone:570-453-2555
Practice Address - Fax:570-453-1043
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004601-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010714460004Medicaid
PA001874Other1ST PRIORITY PROVIDER #
PA110160680OtherRAILROAD MEDICARE #
PA010063200OtherBLACK LUNG PROVIDE #
PA126801OtherBLUE SHIELD PROVIDER #
PA001874Other1ST PRIORITY PROVIDER #
PA122414Medicare PIN