Provider Demographics
NPI:1477702157
Name:EDICK, STACEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:EDICK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:PACT, 7TH FLOOR FALK MEDICAL BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-9913
Mailing Address - Fax:412-647-7951
Practice Address - Street 1:3601 5TH AVE
Practice Address - Street 2:FALK MEDICAL BUILDING, 7TH FLOOR PACT
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3403
Practice Address - Country:US
Practice Address - Phone:412-647-9913
Practice Address - Fax:412-647-7951
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant