Provider Demographics
NPI:1205834249
Name:MACKEY, STEPHANIE ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 HUNTERS PATH
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1744
Mailing Address - Country:US
Mailing Address - Phone:717-413-7721
Mailing Address - Fax:
Practice Address - Street 1:1027 HUNTERS PATH
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1744
Practice Address - Country:US
Practice Address - Phone:717-413-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-03-02
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
PAMD055612L208D00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02891200OtherCAPITAL BLUE CROSS
PA20007782OtherAMERIHEALTH MERCY
PA783381OtherMEDICARE LEGACY PROVIDER
PA070013934OtherRR MEDICARE
PA070013934OtherRR MEDICARE