Provider Demographics
NPI:1649313354
Name:STINGONE, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:STINGONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-612-5438
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:TRAUMA DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-612-4064
Practice Address - Fax:215-612-5438
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29340208600000X
PAMD442723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3845651000OtherKEYSTONE IBC
PA2637616OtherHIGHMARK BLUE SHIELD
PA1026121960001Medicaid
PA2637616OtherHIGHMARK BLUE SHIELD