Provider Demographics
NPI:1538328927
Name:MULCAHY, STACI BOTWIN (DO)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:BOTWIN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STACI
Other - Middle Name:LYNN
Other - Last Name:BOTWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:310 STOKE PARK RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9429
Mailing Address - Country:US
Mailing Address - Phone:484-821-3688
Mailing Address - Fax:
Practice Address - Street 1:310 STOKE PARK RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9429
Practice Address - Country:US
Practice Address - Phone:484-821-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009647L207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine