Provider Demographics
NPI:1891804944
Name:STEPHEN A. STURTZ, DO PC
Entity Type:Organization
Organization Name:STEPHEN A. STURTZ, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-535-4100
Mailing Address - Street 1:6557 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2918
Mailing Address - Country:US
Mailing Address - Phone:215-535-1900
Mailing Address - Fax:215-535-7950
Practice Address - Street 1:6557 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2918
Practice Address - Country:US
Practice Address - Phone:215-535-1900
Practice Address - Fax:215-535-7950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN A STURTZ DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADD2597OtherRAILROAD MEDICARE
PA0591263Medicaid
PADD2597OtherRAILROAD MEDICARE
B35137Medicare UPIN