ST. LUKE'S PHYSICIAN GROUP, INC. (NPI# 1790341212) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790341212 |
| Entity Type | Organization |
| Organization Name | ST. LUKE'S PHYSICIAN GROUP, INC. |
| Practice Address |
834 Eaton Ave Ste 301 Bethlehem PA 18018-1832 |
| Practice Telephone | 4845267780 |
| Practice Fax Number | 8338167518 |
| Mailing Telephone | 4845267780 |
| Mailing Fax Number | 8338167518 |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2019-05-10 |
| Authorized Official Name | DEAN EVANS (PRESIDENT) |
| Authorized Official Telephone | 4845264999 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. LUKE'S PHYSICIAN GROUP, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| St. Luke's Pediatric Nephrology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225645518 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 723 Coal St, Easton, PA 18042-6556 | 2020-09-30 |
| 1093322380 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 990 Echo Trl, Easton, PA 18040-1014 | 2020-09-30 |
| 1720695141 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 429 Reeder St, Easton, PA 18042-1731 | 2020-09-29 |
| 1710594130 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1709 Richmond Rd, Easton, PA 18040-8435 | 2020-09-29 |
| 1528675345 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1315 Echo Trl, Easton, PA 18040-1019 | 2020-09-25 |
| 1164039996 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1243 Tatamy Rd, Easton, PA 18045-7405 | 2020-09-25 |
| 1578170304 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1221 Northampton St, Easton, PA 18042-4138 | 2020-09-25 |
| 1144834649 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 257 Brodhead Rd, Bethlehem, PA 18017-8938 | 2020-09-02 |
| 1689288110 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1021 Calypso Ave, Bethlehem, PA 18018-5005 | 2020-09-02 |
| 1962016477 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1621 Catasauqua Rd, Bethlehem, PA 18017-7407 | 2020-09-02 |
| Street Address |
834 EATON AVE STE 301 |
| City | BETHLEHEM |
| State | PA |
| Zip Code | 18018-1832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396973178 | Ravi Agrawal | Internal Medicine | 834 Eaton Ave Ste 301, Bethlehem, PA 18018-1832 | 2009-06-30 |
| 1881236933 | Danica Hannis | Nurse Practitioner | 834 Eaton Ave Ste 301, Bethlehem, PA 18018-1832 | 2019-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093373292 | Jade Madison Hennessy | Specialist/Technologist | Moravian College, 1200 Main Street, Bethlehem, PA 18018 | 2019-06-03 |
| 1780106179 | Courtney Jane Kruscavage | Specialist/Technologist | 641 Dellwood Street, Bethlehem, PA 18018 | 2017-07-07 |
| 1205357936 | Balanced Body Therapeutic Massage, LLC | Massage Therapist | 227 W Broad St Ste 102, Bethlehem, PA 18018 | 2017-07-03 |
| 1033567599 | Jessamine Martin | Counselor | 1 East Broad Street, Suite 510, Bethlehem, PA 18018 | 2016-05-25 |
| 1841650041 | Akhi Saha | Internal Medicine | 325 W Broad St Fl 1, Bethlehem, PA 18018 | 2016-03-01 |
| 1063804193 | Paul Minh Le | Internal Medicine | 800 Eaton Ave Ste B, Bethlehem, PA 18018 | 2015-02-26 |
| 1578962841 | Elizabeth Veronica Weiss Iobst | Counselor | 1754 W. Broad St., Bethlehem, PA 18018 | 2014-08-22 |
| 1255771739 | Inner Resources Counseling Inc | Counselor | 807 West Broad St, Bethlehem, PA 18018 | 2013-06-28 |
| 1437404878 | St Luke Hospital | General Acute Care Hospital | 1956 C Allwood Dr., Bethlehem, PA 18018 | 2012-07-23 |
| 1275802944 | St. Luke's Physician Group, Inc | Ophthalmology | 800 Eaton Avenue, Suite 101, Bethlehem, PA 18018 | 2011-12-23 |
| Find all providers in zip 18018 | ||||
| Taxonomy Code | 2080P0210X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Nephrology |
| A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568000461 | Stc Pediatrics LLC | Pediatrics | 153 Brodhead Rd, Bethlehem, PA 18017-8931 | 2019-12-11 |
| 1386288744 | Stc Pediatrics LLC | Pediatrics | 153 Brodhead Rd, Bethlehem, PA 18017-8931 | 2019-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386018844 | Brenda Cooperstone | Pediatrics | 394 Strathmore Dr, Bryn Mawr, PA 19010-1261 | 2015-11-20 |
| 1891037644 | Martin Sander Polinsky | Pediatrics | 953 Caledonia St, Philadelphia, PA 19128-1129 | 2013-03-20 |
| 1306135769 | Ruth Panzer Gottlieb | Pediatrics | 3300 Darby Rd Apt 5213, Haverford, PA 19041-7706 | 2011-04-06 |
| 1588826317 | Seth Schulman | Pediatrics | 15 Beth Dr, Ambler, PA 19002-1930 | 2008-07-02 |
| 1609986421 | Yosuke Miyashita | Pediatrics | 4401 Penn Ave / Faculty Pavilion, 44, Children's Hospital of Pittsburgh of Upmc, Pittsburgh, PA 15224 | 2006-08-30 |
| 1265480248 | Jonathan David Heiliczer | Pediatrics | St. Christopher's Hospital for Children, Erie Avenue At Front Street, Philadelphia, PA 19134-1095 | 2006-05-04 |
| 1932106077 | Carlton M Bates | Pediatrics | Upmc Children's Hospital of Pittsburgh, 4401 Penn Avenue, Rangos 5th Floor, Room 5130, Pittsburgh, PA 15201 | 2005-07-05 |
| 1730715830 | Katie Sullivan | Pediatrics | 3401 Civic Center Blvd, Philadelphia, PA 19104-4319 | 2020-03-20 |
| 1760026991 | Stc Pediatrics LLC | Pediatrics | 500 York Rd Ste 250, Jenkintown, PA 19046-2870 | 2019-10-31 |
| 1699319038 | Stc Pediatrics LLC | Pediatrics | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2019-10-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.