Provider Demographics
NPI:1740247956
Name:STOLTZFUS, JOHN MICHAEL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:STOLTZFUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:J
Other - Middle Name:MICHAEL
Other - Last Name:STOLTZFUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1012 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3468
Mailing Address - Country:US
Mailing Address - Phone:814-382-3100
Mailing Address - Fax:814-382-0872
Practice Address - Street 1:1012 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3468
Practice Address - Country:US
Practice Address - Phone:814-382-3100
Practice Address - Fax:814-382-0872
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002257L363A00000X, 363A00000X
OH50.002997207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00019645OtherRAILROAD MEDICARE
PAP00019645OtherRAILROAD MEDICARE
PA192223ZC4DMedicare PIN
OHPA34802Medicare PIN
PAP59850Medicare UPIN
PA159158ZC4DMedicare PIN
PA115270L5BMedicare PIN