Provider Demographics
NPI:1124082185
Name:PAXSON, STEPHEN G (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:PAXSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GREENVILLE PLZ
Mailing Address - Street 2:HADLEY ROAD
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1240
Mailing Address - Country:US
Mailing Address - Phone:724-588-8884
Mailing Address - Fax:724-588-8931
Practice Address - Street 1:10 GREENVILLE PLZ
Practice Address - Street 2:HADLEY ROAD
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1240
Practice Address - Country:US
Practice Address - Phone:724-588-8884
Practice Address - Fax:724-588-8931
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004740L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10504280003Medicaid
OH0846688Medicaid
PA10504280003Medicaid
OH0846688Medicaid