Provider Demographics
NPI:1912944638
Name:WIERCINSKI, STANLEY RAYMOND (DO)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:RAYMOND
Last Name:WIERCINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 GILPIN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3272
Mailing Address - Country:US
Mailing Address - Phone:302-468-4320
Mailing Address - Fax:888-905-1904
Practice Address - Street 1:1021 GILPIN AVE STE 203
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3272
Practice Address - Country:US
Practice Address - Phone:302-468-4320
Practice Address - Fax:888-905-1904
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0004368207VC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000516710Medicaid
DE0000516710Medicaid
436908Medicare ID - Type Unspecified