Provider Demographics
NPI:1134232242
Name:STOUDT, CALVIN D (DO)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:STOUDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 TUNNEL RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3869
Mailing Address - Country:US
Mailing Address - Phone:570-622-5455
Mailing Address - Fax:570-622-5493
Practice Address - Street 1:700 SCHUYLKILL MANOR RD
Practice Address - Street 2:SUITE 1
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3849
Practice Address - Country:US
Practice Address - Phone:570-622-5672
Practice Address - Fax:570-622-6099
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007634L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17281Medicare UPIN
PA779606Medicare PIN