Provider Demographics
NPI:1932108701
Name:MONACO, STEPHEN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:MONACO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4929
Mailing Address - Country:US
Mailing Address - Phone:610-446-1392
Mailing Address - Fax:610-449-2933
Practice Address - Street 1:1120 W TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4929
Practice Address - Country:US
Practice Address - Phone:610-446-1392
Practice Address - Fax:610-449-2933
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002625L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29731Medicare UPIN
PA155201Medicare PIN
PA155201Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER