Individual
DR. MARK A STEFANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2647 GRAND AVE, ASTORIA, OR 97103-3329
(503) 739-6164
Mailing address
2647 GRAND AVE, ASTORIA, OR 97103-2915
(503) 739-6164
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD19990
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130263
OMAP
OR
Enumeration date
06/15/2006
Last updated
03/13/2009
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