Healthcare Provider Details

I. General information

NPI: 1164477543
Provider Name (Legal Business Name): JOHN L STEFANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN-STANTON ROAD SUITE 217 MEDICAL ARTS PAVILION ONE
NEWARK DE
19713
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-2374
  • Fax: 302-733-2602
Mailing address:
  • Phone: 302-733-2374
  • Fax: 302-733-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number51812
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberCI0002751
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: