Healthcare Provider Details

I. General information

NPI: 1023742996
Provider Name (Legal Business Name): STEFAN CHARLES HUTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

723 WHEATLAND ST APT 201
PHOENIXVILLE PA
19460-5309
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8000
  • Fax:
Mailing address:
  • Phone: 347-750-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT233254
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: