Basic Information
| Provider Information | |||||||||
| NPI: | 1396795399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOUT | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S CEDAR CREST BLVD. | ||||||||
| Address2: | 3RD FLOOR ANDERSON WING | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104025369 | ||||||||
| FaxNumber: | 6104025959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 S CEDAR CREST BLVD. | ||||||||
| Address2: | 3RD FLOOR ANDERSON WING | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104025369 | ||||||||
| FaxNumber: | 6104025959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS012250 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | OS012250 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00165766 | 01 | PA | PALMETTO GBA MEDICARE | OTHER | 50044398 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1619023 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER |