Provider Demographics
NPI:1609981968
Name:STARK, STACY M (DO)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:STARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:M
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9472
Mailing Address - Country:US
Mailing Address - Phone:484-554-3827
Mailing Address - Fax:
Practice Address - Street 1:115 TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-9472
Practice Address - Country:US
Practice Address - Phone:484-554-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013789208100000X
TNDO2565208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation