Provider Demographics
NPI:1649249632
Name:CENEDELLA, STEPHEN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:CENEDELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 PROSPECT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-2542
Mailing Address - Country:US
Mailing Address - Phone:814-423-4774
Mailing Address - Fax:814-432-8648
Practice Address - Street 1:150 PROSPECT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2542
Practice Address - Country:US
Practice Address - Phone:814-423-4774
Practice Address - Fax:814-432-8648
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013634E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000729295Medicaid
PA000729295Medicaid