Provider Demographics
NPI:1972504066
Name:STANKIEWICZ, EDWARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:STANKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1579 CHICHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4208
Mailing Address - Country:US
Mailing Address - Phone:610-485-5800
Mailing Address - Fax:610-485-1421
Practice Address - Street 1:1579 CHICHESTER AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:PA
Practice Address - Zip Code:19061-4208
Practice Address - Country:US
Practice Address - Phone:610-485-5800
Practice Address - Fax:610-485-1421
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 039652-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine