Provider Demographics
NPI:1992189815
Name:MILLER, STACEY BARRON (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BARRON
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-6886
Mailing Address - Fax:412-359-3598
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-6886
Practice Address - Fax:412-359-3598
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453619207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103058437Medicaid
PA103058437Medicaid