Healthcare Provider Details

I. General information

NPI: 1710136429
Provider Name (Legal Business Name): STEPHEN P KROTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 WEST 26TH STREET
ERIE PA
16508
US

IV. Provider business mailing address

1781 WEST 26TH STREET
ERIE PA
16508
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-8960
  • Fax: 814-480-8970
Mailing address:
  • Phone: 814-480-8960
  • Fax: 814-480-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOKO000039
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS015703
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015703
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: