Provider Demographics
NPI:1295849859
Name:MORAN, STACY LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNNE
Last Name:MORAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HOSPITAL RD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3662
Mailing Address - Country:US
Mailing Address - Phone:724-464-0270
Mailing Address - Fax:724-464-0274
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-464-0270
Practice Address - Fax:724-464-0274
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172315Q8MOtherMEDICARE ID #
PA172315Q8MOtherMEDICARE ID #