Provider Demographics
NPI:1922068634
Name:HAUPTMAN, STEPHEN P (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:HAUPTMAN
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 1:2601 PENNSYLVANIA AVE
Mailing Address - Street 2:UNIT C6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2312
Mailing Address - Country:US
Mailing Address - Phone:215-564-4880
Mailing Address - Fax:215-564-4890
Practice Address - Street 1:2601 PENNSYLVANIA AVE
Practice Address - Street 2:UNIT C6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2348
Practice Address - Country:US
Practice Address - Phone:215-564-4880
Practice Address - Fax:215-564-4890
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002026L207KI0005X, 207RH0000X
PAOS0020260L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007079210007Medicaid
PA0054467000OtherAMERIHEALTH
PA232939425OtherUNITED HEALTHCARE
PA000132832OtherAPWU HEALTH PLAN
PA53725OtherAETNA HEALTH MANAGEMENT,L
PA000155566OtherHIGHMARK BLUE SHIELD
PA000155566OtherINDEPENDENCE BLUE CROSS
PA18553OtherHEALTH PARTNERS
PA232939425OtherRELIGIOUS MEDICAL
PA232939425OtherCIGNA
PA232939425OtherPENNSYLVANIA EMPLOYEES BE
PA0070792101OtherHMA
PA000155566OtherINDEPENDENCE BLUE CROSS
PA155566Medicare ID - Type Unspecified