Provider Demographics
NPI:1780605204
Name:KATCHMAN, STACY D (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:D
Last Name:KATCHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:410 W LINFIELD TRAPPE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4203
Mailing Address - Country:US
Mailing Address - Phone:610-495-6500
Mailing Address - Fax:610-495-6556
Practice Address - Street 1:410 W LINFIELD TRAPPE RD STE 240
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4203
Practice Address - Country:US
Practice Address - Phone:610-495-6500
Practice Address - Fax:610-495-6556
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061481L207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0037044Medicaid
NJ0037044Medicaid