Provider Demographics
NPI:1689643660
Name:STOUDT, MICHELLE L (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:STOUDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:303 BENNER PK STE 1
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7304
Practice Address - Country:US
Practice Address - Phone:814-272-5660
Practice Address - Fax:814-272-5675
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008587L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017454350004Medicaid
PA0017454350004Medicaid
G90384Medicare UPIN
PA026159Medicare PIN