Mazzacco, Stacey Louise
Mazzacco, Stacey Louise is an individual health care provider with primary practice located at 2104 Harrisburg Pike Ste 200, Lancaster PA 17601-2644. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is her primary health care specialty. Mazzacco, Stacey Louise can be contacted via phone (717) 544-3626.Contact Information
Primary practice address
2104 Harrisburg Pike Ste 200
Lancaster PA 17601-2644
Phone: (717) 544-3626
Fax: (717) 544-3628
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD053932L | Pennsylvania |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | MD053932L | Pennsylvania |
Profile Details
| NPI number | 1265413207 |
|---|---|
| LBN Legal business name | Mazzacco, Stacey Louise |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 8th, 2005 |
| Last updated | Sep 30th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265413207 | NPPES |
| Pennsylvania | MEDICAID | 0178844 | |
| Pennsylvania | Other | 020048899 |
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