Provider Demographics
NPI:1245250612
Name:NOONE, STEPHEN R (DPM)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:NOONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 BERLIN RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3573
Mailing Address - Country:US
Mailing Address - Phone:856-795-1003
Mailing Address - Fax:856-795-5994
Practice Address - Street 1:52 BERLIN RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3573
Practice Address - Country:US
Practice Address - Phone:856-795-1003
Practice Address - Fax:856-795-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00265900213E00000X
PASC004617L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01868201Medicaid
NJ8691207Medicaid
NJ60984OtherAMERIGROUP
9209717OtherPHCS
P2532063OtherOXFORD INSURANCE
PA214416500OtherKEYSTONE HEALTH PLAN
PA1459159OtherINDEPENDENCE BLUE CROSS
NJ01000755800OtherAMERICHOICE OF NJ
P00152413OtherRAILROAD MEDICARE
NJ0283477OtherCIGNA
NJ0000048688Medicare NSC
NJ8691207Medicaid
PA1459159OtherINDEPENDENCE BLUE CROSS
PA060361FHAMedicare PIN
P2532063OtherOXFORD INSURANCE