Provider Demographics
NPI:1366435554
Name:STUART, WAYNE C (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:C
Last Name:STUART
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 1:2053 MAJESTIC OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5506
Mailing Address - Country:US
Mailing Address - Phone:610-653-7681
Mailing Address - Fax:610-954-0744
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1573
Practice Address - Country:US
Practice Address - Phone:215-538-4500
Practice Address - Fax:215-538-4500
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051543L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014651000012Medicaid
PAF89849Medicare UPIN
PA043694Medicare ID - Type Unspecified