Healthcare Provider Details

I. General information

NPI: 1508037599
Provider Name (Legal Business Name): RICHARD G. STUEMPFLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 E CHURCH ST
LOCK HAVEN PA
17745-2556
US

IV. Provider business mailing address

36 E CHURCH ST
LOCK HAVEN PA
17745-2556
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-5527
  • Fax:
Mailing address:
  • Phone: 570-748-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC-OOO444L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberSC-000444L
License Number StatePA

VIII. Authorized Official

Name: RICHARD G. STUEMPFLE
Title or Position: OWNER
Credential: DPM
Phone: 570-748-5527