Healthcare Provider Details

I. General information

NPI: 1568681336
Provider Name (Legal Business Name): STACY LANE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ANDERSON ST SUITE 101 TIMBER COURT
PITTSBURGH PA
15212-5803
US

IV. Provider business mailing address

127 ANDERSON ST SUITE 101 TIMBER COURT
PITTSBURGH PA
15212-5803
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-4151
  • Fax: 844-389-1405
Mailing address:
  • Phone: 412-322-4151
  • Fax: 844-389-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS012906
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: