Healthcare Provider Details

I. General information

NPI: 1073513784
Provider Name (Legal Business Name): TIMOTHY B STONESIFER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 W KING ST SUITE C
SHIPPENSBURG PA
17257-1233
US

IV. Provider business mailing address

67 W KING ST SUITE C
SHIPPENSBURG PA
17257-1233
US

V. Phone/Fax

Practice location:
  • Phone: 717-530-1698
  • Fax: 717-530-5186
Mailing address:
  • Phone: 717-530-1698
  • Fax: 717-530-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007960L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: