Provider Demographics
NPI:1548262355
Name:LONGENECKER, STEPHEN C (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:LONGENECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9202
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9202
Mailing Address - Country:US
Mailing Address - Phone:610-376-8671
Mailing Address - Fax:610-376-6387
Practice Address - Street 1:301 S 7TH AVE STE 365
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1436
Practice Address - Country:US
Practice Address - Phone:484-628-2663
Practice Address - Fax:484-628-2621
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-039816-E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011960480002Medicaid
PA01953001OtherCAPITAL BLUE CROSS
PAL0599276OtherBLUE SHEILD
PA0011960480002Medicaid
PAL0599276OtherBLUE SHEILD