Provider Demographics
NPI:1124133590
Name:GITTLEN, STANFORD D (MD)
Entity type:Individual
Prefix:MR
First Name:STANFORD
Middle Name:D
Last Name:GITTLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1980 SOUTH EASTON ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-348-1310
Mailing Address - Fax:215-348-8615
Practice Address - Street 1:1980 SOUTH EASTON ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-348-1310
Practice Address - Fax:215-348-8615
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA029887E207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012592370001Medicaid
PA473043G06Medicare ID - Type Unspecified
PA0012592370001Medicaid