Provider Demographics
NPI:1063732188
Name:STEIN, RONEN ELAD (MD)
Entity type:Individual
Prefix:
First Name:RONEN
Middle Name:ELAD
Last Name:STEIN
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 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC GASTROENTEROLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-7801
Mailing Address - Fax:215-590-3606
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC GASTROENTEROLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-7801
Practice Address - Fax:215-590-3606
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD448463208000000X
PAMT2032592080P0206X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program