Provider Demographics
NPI:1548266950
Name:STEFANICK, PATTI ANN (DO, FACOS)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:ANN
Last Name:STEFANICK
Suffix:
Gender:F
Credentials:DO, FACOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SAINT CLAIR RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1648
Mailing Address - Country:US
Mailing Address - Phone:814-255-1688
Mailing Address - Fax:
Practice Address - Street 1:939 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2838
Practice Address - Country:US
Practice Address - Phone:814-255-7882
Practice Address - Fax:814-255-7885
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 005514L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011830210001Medicaid
PAST469423OtherBCBS
PAST469423OtherBCBS
PAE21959Medicare UPIN