Provider Demographics
NPI:1841432119
Name:STOUFFER, PEGGY KATHLEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:KATHLEEN
Last Name:STOUFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1205 YORK ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6211
Mailing Address - Country:US
Mailing Address - Phone:410-296-8001
Mailing Address - Fax:410-296-8060
Practice Address - Street 1:1205 YORK ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:410-296-8001
Practice Address - Fax:410-296-8060
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC02218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant