Basic Information
| Provider Information | |||||||||
| NPI: | 1801898028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 ROYAL RD | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170429543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172740040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 229 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170426158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172733758 | ||||||||
| FaxNumber: | 7172721734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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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 | 208600000X | MD023688E | PA | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | MD023688E | PA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208C00000X | MD023688E | PA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1007291170004 | 05 | PA | MEDICAID | 183586 | 01 | PA | RR MEDICARE/PALMETTO GBA | OTHER | 183586 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 02526500 | 01 | PA | CAIC | OTHER |