Provider Demographics
NPI:1770540270
Name:STANKIEWICZ, ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:STANKIEWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1640
Mailing Address - Country:US
Mailing Address - Phone:814-539-5987
Mailing Address - Fax:814-535-4176
Practice Address - Street 1:290 HAIDA AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646-5610
Practice Address - Country:US
Practice Address - Phone:814-539-5987
Practice Address - Fax:814-535-4176
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005258L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011145700002Medicaid
PA0011145700003Medicaid
PA444087Medicare ID - Type Unspecified
PA0011145700002Medicaid