Individual provider Active NPI

Rudolf L Laveran-Stiebar, MD

  • Obstetrics & Gynecology Physician
  • Broomall, PA
National Provider Identifier
1487625323
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD061210L Issued in PA
Practice address
1991 Sproul Rd
Suite 200 Main Line Health Center
Broomall, PA 19008-3518
Phone
(610) 325-1350
Fax
(610) 325-1357
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD061210L PA Primary

Addresses

Primary practice location

1991 Sproul Rd
Suite 200 Main Line Health Center
Broomall, PA 19008-3518

Mailing address

1991 Sproul Rd
Suite 200 Main Line Health Center
Broomall, PA 19008-3518
Phone (610) 325-1350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090318000225 PA Practitioner - Obstetrics/Gynecology 2062579030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Perelman School of Med at the University of Pennsylvania, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Wynewood, PA 19096-3450

1991 Sproul Rd
Broomall, PA 19008-3518

830 Old Lancaster Rd
Bryn Mawr, PA 19010-3118

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD061210LPAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Obstetrics & Gynecology CurrentSince Nov 10, 1997 Accepting new patients
Obstetrics & Gynecology Fund Obstetrics & Gynecology Past Accepting new patients

Locations

1991 Sproul Rd
Ste 200
Broomall, PA 19008
Phone (610) 325-1350

1991 Sproul Rd
#200
Broomall, PA 19008

1991 Sproul Rd
Ste 300
Broomall, PA 19008
Phone (610) 325-1373

1991 Sproul Rd
Ste 150
Broomall, PA 19008
Phone (610) 325-1350

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

1100 E Hector St
Ste 105
Conshohocken, PA 19428
Phone (610) 828-2608

100 E Lancaster Ave
Ste 301
Wynnewood, PA 19096
Phone (484) 476-4650

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1487625323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1991 SPROUL RD",
            "address_2": "SUITE 200 MAIN LINE HEALTH CENTER",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083518",
            "telephone_number": "610-325-1350",
            "fax_number": "610-325-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 SPROUL RD",
            "address_2": "SUITE 200 MAIN LINE HEALTH CENTER",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083518",
            "telephone_number": "610-325-1350",
            "fax_number": "610-325-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVERAN-STIEBAR",
        "first_name": "RUDOLF",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD061210L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomall, PA

Sources for this page

Verify at the official NPI Registry.