Basic Information
| Provider Information | |||||||||
| NPI: | 1629056296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILBACK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 NORLAND AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176760 | ||||||||
| FaxNumber: | 7172176702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A68585 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD431227 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1710048 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | MD431227 | 01 | PA | LICENSE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 2169007 | 01 | PA | MAMSI | OTHER | 9563094 | 01 | PA | AETNA NON-HMO | OTHER | P00421647 | 01 | PA | RAILROAD MEDICARE | OTHER | 102027294 0001 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | GREATWEST HEALTHCARE | OTHER | FM0293807 | 01 | PA | DEA | OTHER | 120420409 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | U811-0009 | 01 | PA | CAREFIRST DC | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 913162-01 | 01 | PA | CAREFIRST MD | OTHER | P009306 | 01 | PA | GATEWAY | OTHER | 0018878330001 | 05 | PA | MEDICAID | 1831119221 | 01 | PA | CAPITAL BLUECROSS | OTHER | 728028 | 01 | PA | HEALTH AMERICA | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | MI985611 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 225564 | 01 | PA | UNISON | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER |