Provider Demographics
NPI:1760462063
Name:FITCH, STACEY L (DO)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:FITCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3241
Mailing Address - Country:US
Mailing Address - Phone:610-327-4200
Mailing Address - Fax:610-327-8160
Practice Address - Street 1:1566 MEDICAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3229
Practice Address - Country:US
Practice Address - Phone:484-945-0075
Practice Address - Fax:484-945-0781
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009934L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057235D8PMedicare PIN
H60336Medicare UPIN