Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS035655 | PA |
N | 1223P0106X | Oral and Maxillofacial Pathology | MD422877 | PA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS035655 | PA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | MO422877 | PA |
NPI | 1366474314 |
---|---|
Provider Name | Dr. Stephen L Engroff |
First Address | State College, PA 16801 |
Second Address | State College, PA 16801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50016023 | CAPITAL BUSE CROSS (01) | |
79677 | GEISINGER HEALTH PLAN (01) | |
EN1480132 | HIGHMARK (01) | |
U95938 | (02) |