Provider Demographics
NPI:1801898028
Name:WINER, STEPHEN FRANK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRANK
Last Name:WINER
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 1:225 ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9543
Mailing Address - Country:US
Mailing Address - Phone:717-274-0040
Mailing Address - Fax:
Practice Address - Street 1:229 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6158
Practice Address - Country:US
Practice Address - Phone:717-273-3758
Practice Address - Fax:717-272-1734
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023688E208600000X, 2086S0120X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007291170004Medicaid
PA183586OtherRR MEDICARE/PALMETTO GBA
PA183586OtherHIGHMARK BLUE SHIELD
PA02526500OtherCAIC
PA183586OtherRR MEDICARE/PALMETTO GBA
PAB39759Medicare UPIN