Provider Demographics
NPI:1538265814
Name:MECHANICK, STEPHEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MECHANICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14 ELLIOTT AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3412
Mailing Address - Country:US
Mailing Address - Phone:610-526-1780
Mailing Address - Fax:610-526-1637
Practice Address - Street 1:14 ELLIOTT AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3412
Practice Address - Country:US
Practice Address - Phone:610-526-1780
Practice Address - Fax:610-526-1637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038636E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40829Medicare UPIN
PAME183095Medicare ID - Type Unspecified