Provider Demographics
NPI:1790771392
Name:STEVENS, PHILIP J (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1102 BERGAN RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2506
Mailing Address - Country:US
Mailing Address - Phone:215-233-2790
Mailing Address - Fax:215-233-9261
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8123
Practice Address - Fax:215-233-2790
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004703L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0022667000OtherKEYSTONE
PA57146OtherAETNA
PA371319OtherUHC
PAE63976Medicare UPIN
PA57146OtherAETNA