Provider Demographics
NPI:1831361187
Name:UNDERWOOD, STEPHEN GEORGE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GEORGE
Last Name:UNDERWOOD
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 1:623 GLENMARY RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4433
Mailing Address - Country:US
Mailing Address - Phone:610-989-1600
Mailing Address - Fax:717-705-8179
Practice Address - Street 1:623 GLENMARY RD
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4433
Practice Address - Country:US
Practice Address - Phone:610-989-1600
Practice Address - Fax:717-705-8179
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041654L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry