Healthcare Provider Details

I. General information

NPI: 1245271055
Provider Name (Legal Business Name): STANLEY MURAVCHICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 6 DULLES
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST 6 DULLES
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8310
  • Fax:
Mailing address:
  • Phone: 215-349-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD024745E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: