Provider Demographics
NPI:1871595041
Name:HUMBERT, STEPHEN M (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:HUMBERT
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 1:2510 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5212
Mailing Address - Country:US
Mailing Address - Phone:484-450-4500
Mailing Address - Fax:484-450-0575
Practice Address - Street 1:2510 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5212
Practice Address - Country:US
Practice Address - Phone:484-450-4500
Practice Address - Fax:484-450-0575
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007256L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014679730001Medicaid
PA0014679730001Medicaid
PA110081128Medicare PIN