Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD058050L | PA |
N | 2080P0204X | Pediatric Emergency Doctor | MD058050L | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD058050L | PA |
NPI | 1154339570 |
---|---|
Provider Name | Stephan A Grupp |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001575649 | (05) | PA |
7224109 | (05) | NJ |
E54938 | (02) |