Provider Demographics
NPI:1669556171
Name:LEVICK, STACI L
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:L
Last Name:LEVICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401
Mailing Address - Country:US
Mailing Address - Phone:610-279-1414
Mailing Address - Fax:610-279-4725
Practice Address - Street 1:60 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-279-1414
Practice Address - Fax:610-279-4725
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSD07490L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001600189002Medicaid
783840OtherBLUE SHIELD OF PA
PA1044866OtherKEYSTONE MERCY
PA1044866OtherKEYSTONE MERCY
G12006Medicare UPIN