Provider Demographics
NPI:1952330276
Name:STIEG, FREDERIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:C
Last Name:STIEG
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 1:1305 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2929
Mailing Address - Country:US
Mailing Address - Phone:610-482-4949
Mailing Address - Fax:610-482-4950
Practice Address - Street 1:1305 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2929
Practice Address - Country:US
Practice Address - Phone:610-482-4949
Practice Address - Fax:610-482-4950
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019243E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB82219Medicare UPIN
NJ076409Medicare ID - Type UnspecifiedPROVIDER NUMBER