Provider Demographics
NPI:1023037546
Name:KRISHER, STACY L (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:KRISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:VENTICINQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3300 TILLMAN DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2071
Mailing Address - Country:US
Mailing Address - Phone:215-633-3456
Mailing Address - Fax:215-245-5491
Practice Address - Street 1:3300 TILLMAN DR
Practice Address - Street 2:SUITE #100
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2071
Practice Address - Country:US
Practice Address - Phone:215-633-3456
Practice Address - Fax:215-245-5491
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA MD 0734497L2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology