Healthcare Provider Details

I. General information

NPI: 1144386582
Provider Name (Legal Business Name): STEPHANIE A MCKNIGHT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MONTGOMERY AVE FL 4
PENN VALLEY PA
19072-1548
US

IV. Provider business mailing address

915 MONTGOMERY AVE FL 4
PENN VALLEY PA
19072-1548
US

V. Phone/Fax

Practice location:
  • Phone: 610-668-7992
  • Fax: 610-668-7991
Mailing address:
  • Phone: 610-668-7992
  • Fax: 610-668-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberMD431078
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberMD431078
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD431078
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: