Healthcare Provider Details

I. General information

NPI: 1003575457
Provider Name (Legal Business Name): STEPHEN MICHAEL PISTOIA JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY STE 110
LEWES DE
19958-1772
US

IV. Provider business mailing address

34031 SANDCASTLE DR N
MILLSBORO DE
19966-6009
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6400
  • Fax:
Mailing address:
  • Phone: 609-929-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: