Provider Demographics
NPI:1871554691
Name:STINE, KARL F (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:F
Last Name:STINE
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-0265
Mailing Address - Country:US
Mailing Address - Phone:814-934-5275
Mailing Address - Fax:814-787-2955
Practice Address - Street 1:207 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1141
Practice Address - Country:US
Practice Address - Phone:814-934-5275
Practice Address - Fax:814-787-2955
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039660L207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001024188Medicaid
PA053962Medicare PIN