Provider Demographics
NPI:1679584460
Name:SMULLENS, STANTON N (MD)
Entity type:Individual
Prefix:DR
First Name:STANTON
Middle Name:N
Last Name:SMULLENS
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 1:1710 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6702
Mailing Address - Country:US
Mailing Address - Phone:215-732-1555
Mailing Address - Fax:
Practice Address - Street 1:259 N RADNOR CHESTER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5240
Practice Address - Country:US
Practice Address - Phone:610-225-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028277L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery