MEDICARE: DR. STACI BOTWIN MULCAHY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	OS-009647L	PA

General Provider Information

NPI Number	:	1538328927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI BOTWIN MULCAHY D.O.

Provider Business Mailing Address
First Line	:	310 STOKE PARK RD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-9429
Country	:	US
Telephone Number	:	484-821-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 STOKE PARK RD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-9429
Country	:	US
Telephone Number	:	484-821-3688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	03/23/2015

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