Healthcare Provider Details

I. General information

NPI: 1952714040
Provider Name (Legal Business Name): JEFFREY CAIN STEVENS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE STE 330
PAOLI PA
19301-1766
US

IV. Provider business mailing address

255 W. LANCASTER AVE SUITE 330
PAOLI PA
19301
US

V. Phone/Fax

Practice location:
  • Phone: 610-786-3200
  • Fax: 610-786-3208
Mailing address:
  • Phone: 610-786-3200
  • Fax: 610-786-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS018780
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: