Provider Demographics
NPI:1720716327
Name:DRISCOLL, STEPHEN MILLER (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MILLER
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SPRING MILL AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1947
Mailing Address - Country:US
Mailing Address - Phone:215-983-2809
Mailing Address - Fax:
Practice Address - Street 1:300 CREEK CROSSING BLVD STE 307
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2767
Practice Address - Country:US
Practice Address - Phone:609-267-2333
Practice Address - Fax:609-267-2533
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00724400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery