Provider Demographics
NPI:1700078268
Name:CUMMINGS, STACEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:SMITH
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:16 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8029
Practice Address - Country:US
Practice Address - Phone:570-271-5600
Practice Address - Fax:570-271-5851
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046755208000000X
VA0101245931208000000X
PAMD454524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA170078268Medicaid
PA425147OtherMEDICARE