Provider Demographics
NPI:1285603886
Name:EBERWINE, STEPHEN F (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:EBERWINE
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 1:1159 W JEFFERSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2795
Mailing Address - Country:US
Mailing Address - Phone:317-736-6334
Mailing Address - Fax:
Practice Address - Street 1:1159 W JEFFERSON ST STE 102
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-736-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048917A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200248560Medicaid
P00220837Medicare PIN
INH03292Medicare UPIN
IN222750EMedicare PIN