Healthcare Provider Details

I. General information

NPI: 1497850176
Provider Name (Legal Business Name): TIMOTHY S STANTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MAIN AVE
WARREN PA
16365
US

IV. Provider business mailing address

114 MAIN AVE
WARREN PA
16365
US

V. Phone/Fax

Practice location:
  • Phone: 814-723-8240
  • Fax: 814-723-3665
Mailing address:
  • Phone: 814-723-8240
  • Fax: 814-723-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number153655
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003301L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002037L
License Number StatePA

VIII. Authorized Official

Name: TIMOTHY SCOTT STANTON
Title or Position: OWNER
Credential: MD
Phone: 814-723-8240