Healthcare Provider Details

I. General information

NPI: 1174568679
Provider Name (Legal Business Name): STUART L TRAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 8TH ST STE 2C
PHILADELPHIA PA
19106-4017
US

IV. Provider business mailing address

301 S 8TH ST STE 2C
PHILADELPHIA PA
19106-4017
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-7444
  • Fax: 215-829-7674
Mailing address:
  • Phone: 215-829-7444
  • Fax: 215-829-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA08177200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD047881L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-047881-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: