Provider Demographics
NPI:1861432940
Name:SARIS, STEVEN DEMETRIUS (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEMETRIUS
Last Name:SARIS
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 1:130 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1511
Mailing Address - Country:US
Mailing Address - Phone:610-649-3150
Mailing Address - Fax:
Practice Address - Street 1:130 VALLEY RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1511
Practice Address - Country:US
Practice Address - Phone:610-649-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1764551OtherHIGHMARK BLUE SHIELD
PA824299OtherFIRST PRIORITY HEALTH
PA0008507860004Medicaid
PA07801685Medicaid
PA824299OtherFIRST PRIORITY HEALTH
PAP00735535Medicare PIN
PA0008507860004Medicaid