Provider Demographics
NPI:1851374391
Name:STOUDT, KARL DONALD (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:DONALD
Last Name:STOUDT
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 1:1014 LILLIAN DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1525
Mailing Address - Country:US
Mailing Address - Phone:724-342-3456
Mailing Address - Fax:
Practice Address - Street 1:1014 LILLIAN DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1525
Practice Address - Country:US
Practice Address - Phone:724-342-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008586E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006716690004Medicaid
PA0006716690004Medicaid
PA017123RN0Medicare PIN