Provider Demographics
NPI:1295928950
Name:FORD, STACEY G (DO)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:G
Last Name:FORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:740 PENN AVE
Mailing Address - Street 2:PO BOX 7065
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1006
Mailing Address - Country:US
Mailing Address - Phone:610-376-3700
Mailing Address - Fax:610-685-1567
Practice Address - Street 1:740 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1006
Practice Address - Country:US
Practice Address - Phone:610-376-3700
Practice Address - Fax:610-685-1567
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA1S006504L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology