Provider Demographics
NPI:1457419053
Name:STEHMAN, GLENN ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ROBERT
Last Name:STEHMAN
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 1:15 DUTCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9530
Mailing Address - Country:US
Mailing Address - Phone:856-753-8062
Mailing Address - Fax:856-753-3241
Practice Address - Street 1:15 DUTCHTOWN RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9530
Practice Address - Country:US
Practice Address - Phone:856-753-8062
Practice Address - Fax:856-753-3241
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03812800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101910952Medicaid
PA1973530OtherHIGHMARK
PA1973530OtherHIGHMARK