Provider Demographics
NPI:1932210473
Name:STACHER, ERIC DURELL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DURELL
Last Name:STACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370
Mailing Address - Country:US
Mailing Address - Phone:724-852-1710
Mailing Address - Fax:724-852-1833
Practice Address - Street 1:142 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-852-1710
Practice Address - Fax:724-852-1833
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037668L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
28774OtherHEALTH ASSURANCE
ST67882OtherBLUE SHIELD
PA78008Medicaid
PA78008Medicaid