Provider Demographics
NPI:1164470787
Name:SMITH-ELFANT, STACY A (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:SMITH-ELFANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:175 CROSS KEYS RD STE 300A
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05781100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN