Provider Demographics
NPI:1063434520
Name:SMALLOW, STEVAN A (MD)
Entity type:Individual
Prefix:
First Name:STEVAN
Middle Name:A
Last Name:SMALLOW
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 1:2846 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3552
Mailing Address - Country:US
Mailing Address - Phone:215-638-8500
Mailing Address - Fax:215-638-0413
Practice Address - Street 1:2846 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3552
Practice Address - Country:US
Practice Address - Phone:215-638-8500
Practice Address - Fax:215-638-0413
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045798L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1440281Medicaid
PAF03336Medicare UPIN
PA1440281Medicaid