Provider Demographics
NPI:1316979214
Name:MOENNING, STEPHEN P (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:MOENNING
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 1:2720 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9568
Mailing Address - Country:US
Mailing Address - Phone:239-314-4681
Mailing Address - Fax:
Practice Address - Street 1:2720 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9568
Practice Address - Country:US
Practice Address - Phone:239-314-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAME46778208600000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271843000Medicaid
FLD 21254Medicare UPIN
FL271843000Medicaid