Provider Demographics
NPI:1780682815
Name:FLAGG, STEPHANIE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:FLAGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-527-3800
Mailing Address - Fax:610-527-2854
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-527-3800
Practice Address - Fax:610-527-2854
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073853L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019746800003Medicaid
PA0019746800001Medicaid
PA0019746800003Medicaid
PA168334EGWMedicare PIN
PA0019746800001Medicaid