Healthcare Provider Details

I. General information

NPI: 1174518757
Provider Name (Legal Business Name): GEORGE THOMAS STOLLSTEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FLORAL VALE BLVD STE B
YARDLEY PA
19067-5522
US

IV. Provider business mailing address

41 UNIVERSITY DR SUITE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 267-364-9100
  • Fax: 267-364-9101
Mailing address:
  • Phone: 215-710-5522
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD051184L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016448620006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier908535
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 3
Identifier5134565
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA PA
# 4
Identifier5569545
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: