Provider Demographics
NPI:1871828905
Name:GEMBERLING, STACY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:GEMBERLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:BOLLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1 DOCK HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-8910
Practice Address - Country:US
Practice Address - Phone:570-837-5889
Practice Address - Fax:570-837-6600
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054196363A00000X
PAOA002398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031501300001Medicaid
PAOA002398OtherOA LICENSE