Basic Information
| Provider Information | |||||||||
| NPI: | 1033369533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | GORE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1553 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | CRUM LYNNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190221022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104997180 | ||||||||
| FaxNumber: | 6108760859 | ||||||||
| Practice Location | |||||||||
| Address1: | 1553 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | CRUM LYNNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190221022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104997180 | ||||||||
| FaxNumber: | 6108760859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 09/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | MD421701 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.