Provider Demographics
NPI:1699086496
Name:STEFANSKI, MICHAEL J JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:STEFANSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:STEFANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1440
Mailing Address - Country:US
Mailing Address - Phone:717-234-2561
Mailing Address - Fax:717-236-1121
Practice Address - Street 1:50 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043
Practice Address - Country:US
Practice Address - Phone:717-234-2561
Practice Address - Fax:717-236-1121
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452391207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102979520Medicaid