MEDICARE: FRED STUTMAN 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	207Q00000X	Family Medicine Physician	MD007124E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00208191	OTHER	PA	RAILROAD MEDICARE
4	597586	OTHER	PA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0047315	OTHER	PA	AETNA HMO
5	1081468	OTHER	PA	KEYSTONE MERCY HEALTH
6	714	OTHER	PA	BRAVO HEALTH
7	0058304000	OTHER	PA	INDEPENDENCE BLUE CROSS
8	016618	OTHER	PA	HIGHMARK BLUE SHIELD
9	2Y0397	OTHER	PA	HEALTH NET
10	4076190	OTHER		AETNA PPO
11	P495461	OTHER	PA	OXFORD

General Provider Information

NPI Number	:	1780660316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED STUTMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-632-1400
Fax Number	:	215-632-2176

Provider Business Practice Location Address
First Line	:	3501 NEWBERRY RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-2608
Country	:	US
Telephone Number	:	215-632-1400
Fax Number	:	215-632-2176

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/21/2013

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Directions to “ FRED STUTMAN MD” Practice Location

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