Provider Demographics
NPI:1922151679
Name:WILLIAMS, STACEY M (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9381
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:6343 PENN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4010
Practice Address - Country:US
Practice Address - Phone:412-363-2200
Practice Address - Fax:412-363-2214
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD454564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3898868Medicaid
TN3898868Medicaid