Healthcare Provider Details

I. General information

NPI: 1750743720
Provider Name (Legal Business Name): STEPHEN ANTHONY PAGKALINAWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

1845 GERRITT ST
PHILADELPHIA PA
19146-4629
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-2530
  • Fax:
Mailing address:
  • Phone: 201-674-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA11492300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD470539
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11492300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD470539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: