Provider Demographics
NPI:1922057363
Name:O'DONNELL, STEVEN T (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:T
Last Name:O'DONNELL
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 1:2115 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1925
Mailing Address - Country:US
Mailing Address - Phone:814-722-6062
Mailing Address - Fax:814-722-6062
Practice Address - Street 1:2115 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1925
Practice Address - Country:US
Practice Address - Phone:814-722-6062
Practice Address - Fax:814-722-6062
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014076207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024805330001Medicaid
PA185359US8Medicare PIN