Provider Demographics
NPI:1093851669
Name:KOFF, STACEY GRUM (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:GRUM
Last Name:KOFF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10019 KENSINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3430
Mailing Address - Country:US
Mailing Address - Phone:301-962-1864
Mailing Address - Fax:301-295-4280
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-4769
Practice Address - Fax:301-295-4280
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101058328208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology