Healthcare Provider Details
I. General information
NPI: 1417083940
Provider Name (Legal Business Name): STACEY G. FOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/26/2007
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US
IV. Provider business mailing address
18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US
V. Phone/Fax
- Phone: 302-645-8212
- Fax: 302-645-2199
- Phone: 302-645-8212
- Fax: 302-645-2199
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | MD431129 |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | C7-0003006 |
| License Number State | DE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: