Provider Demographics
NPI:1891226536
Name:STODDARD, MARK BEVAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BEVAN
Last Name:STODDARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5520
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-0520
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:610-954-5480
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:610-954-5810
Practice Address - Fax:610-954-5480
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD477774207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology