Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 223128 | MA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 223128 | MA |
NPI | 1003866781 |
---|---|
Provider Name | Dr. Stephen Anthony Olenchock JR. |
First Address | Fountain Hill, PA 18015-1155 |
Second Address | Fountain Hill, PA 18015-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 01/04/2013 |