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General NPI Number Information
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NPI Number | 1891746962
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Entity Type | Individual
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Provider Name | EUGENE R. STISH MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 600 PENN ST
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City | WEST HAZLETON
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State | PA
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Zip | 18202-1514
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Country | US
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Telephone | 570-497-4940
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Fax | 570-497-4942
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Provider Business Mailing Address
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Address Line | PO BOX 1388
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City | KINGSTON
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State | PA
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Zip | 18704-0388
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Country | US
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Telephone | 570-288-8881
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Fax | 570-288-8065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD037411E
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License Number State | PA
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