Provider Demographics
NPI:1831479203
Name:STETSON, DERWOOD LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DERWOOD
Middle Name:LYNN
Last Name:STETSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BALTIMORE RD.
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9421
Mailing Address - Country:US
Mailing Address - Phone:717-532-4715
Mailing Address - Fax:
Practice Address - Street 1:1365 BALTIMORE RD.
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9421
Practice Address - Country:US
Practice Address - Phone:717-532-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA007583E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine