Provider Demographics
NPI:1770582496
Name:STULL, REGINA (PA)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:STULL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1085
Mailing Address - Country:US
Mailing Address - Phone:215-343-4079
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:ABINGTON HOSPITAL- OSI UNIT- 3LENFEST
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-7588
Practice Address - Fax:215-481-3022
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001176L363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1770582496OtherNPI
PAMA001176LOtherPA LICENSE
NJ25MP00115800OtherSTATE LICENSE
NJ25MP00115800OtherSTATE LICENSE
PAMS3062015OtherDEA
PAMA001176LOtherPA LICENSE