Individual provider · NPI-1
Stacy M Stark, DO
Physical Medicine & Rehabilitation · Lebanon, PA
NPI number1609981968
StatusActive
Last updated in NPPESOct 24, 2023
Details
- NPI
- 1609981968
- Entity type
- Individual (NPI-1)
- Name
- Stacy M Stark
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 20, 2006
- Certification date
- Oct 24, 2023
- Last updated
- Oct 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | OS013789 | PA | Yes |
| 208100000X | Physical Medicine & Rehabilitation | DO2565 | TN |
Other names
- Stacy M Bishop (Former Name)
Practice location
115 Tanglewood CtLebanon, PA 17042-9472
Phone 484-554-3827
Mailing address
115 Tanglewood CtLebanon, PA 17042-9472
Phone 484-554-3827
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