Provider Demographics
NPI:1487625323
Name:LAVERAN-STIEBAR, RUDOLF L (MD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:L
Last Name:LAVERAN-STIEBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 200 MAIN LINE HEALTH CENTER
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3518
Mailing Address - Country:US
Mailing Address - Phone:610-325-1350
Mailing Address - Fax:610-325-1357
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 200 MAIN LINE HEALTH CENTER
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3518
Practice Address - Country:US
Practice Address - Phone:610-325-1350
Practice Address - Fax:610-325-1357
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061210L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57095Medicare UPIN
PA001844068Medicaid
G57095Medicare UPIN
PA901465HK1Medicare PIN