Provider Demographics
NPI:1982629556
Name:STANLEY, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:421 CURIE BLVD
Mailing Address - Street 2:100 BRB
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4863
Mailing Address - Country:US
Mailing Address - Phone:215-898-3240
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:1-330S PERELMAN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:215-615-3424
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-11-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD054336L207N00000X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00163494600ZMedicaid
PA00163494600ZMedicaid
PA601108Medicare PIN