Healthcare Provider Details

I. General information

NPI: 1770772147
Provider Name (Legal Business Name): JOHN JOSEPH STEFANCIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 BELMONT AVE
YOUNGSTOWN OH
44504-1135
US

IV. Provider business mailing address

7629 MARKET ST STE 200
YOUNGSTOWN OH
44512-6082
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-2700
  • Fax:
Mailing address:
  • Phone: 330-965-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number090601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: