Provider Demographics
NPI:1831146380
Name:JADITZ, STEPHEN GERARD (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GERARD
Last Name:JADITZ
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:P O BOX 478
Mailing Address - Street 2:
Mailing Address - City:S ABINGTON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9376
Mailing Address - Country:US
Mailing Address - Phone:570-586-8186
Mailing Address - Fax:570-341-5043
Practice Address - Street 1:105 LAYTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9376
Practice Address - Country:US
Practice Address - Phone:570-586-8186
Practice Address - Fax:570-587-0758
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006343L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011317130004Medicaid
PAE64192Medicare UPIN
PA0011317130004Medicaid