Basic Information
| Provider Information | |||||||||
| NPI: | 1346869120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILG | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | KENDALL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | PHIPPSBURG | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045620009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057940493 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1020 SANSOM ST STE 1651B | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159559837 | ||||||||
| FaxNumber: | 2159559870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2020 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.