Provider Demographics
NPI:1376549360
Name:STIERSTORFER, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:STIERSTORFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N SUMNEYTOWN PIKE
Mailing Address - Street 2:STE 1E
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2532
Mailing Address - Country:US
Mailing Address - Phone:215-661-0300
Mailing Address - Fax:215-661-0302
Practice Address - Street 1:311 N SUMNEYTOWN PIKE
Practice Address - Street 2:STE 1E
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2532
Practice Address - Country:US
Practice Address - Phone:215-699-1929
Practice Address - Fax:215-661-0302
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042406E207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00116203000010Medicaid
PA154144OtherBLUE SHIELD
PA2230872OtherAETNA
PA154144Medicare ID - Type Unspecified
PA00116203000010Medicaid