MEDICARE: ALFRED E STILLMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD055071L	PA

General Provider Information

NPI Number	:	1306914635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED E STILLMAN MD

Provider Business Mailing Address
First Line	:	2401 PENNSYLVANIA AVE
Second Line	:	APARTMENT 21B22
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3010
Country	:	US
Telephone Number	:	267-455-0409
Fax Number	:	267-687-2277

Provider Business Practice Location Address
First Line	:	2401 PENNSYLVANIA AVE
Second Line	:	APARTMENT 21B22
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3010
Country	:	US
Telephone Number	:	267-455-0409
Fax Number	:	267-687-2277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/02/2013

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