Provider Demographics
NPI:1245279546
Name:MITROSKY, STEPHEN JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:MITROSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HOME DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-8002
Mailing Address - Country:US
Mailing Address - Phone:814-677-2262
Mailing Address - Fax:814-670-0496
Practice Address - Street 1:124 HOME DEPOT DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-8002
Practice Address - Country:US
Practice Address - Phone:814-677-2262
Practice Address - Fax:814-670-0496
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009358L207R00000X, 207P00000X
PAOS-009358-L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017591090004Medicaid
PAOS-009358LOtherSTATE LICENSE NUMBER
PA01759109Medicaid
PAOS-009358LOtherSTATE LICENSE NUMBER
PA01759109Medicaid
029080Medicare PIN
PA25-1845212OtherTAX ID NUMBER