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General NPI Number Information
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NPI Number | 1629074109
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Entity Type | Individual
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Provider Name | STACY WALTSA LEXOW MD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 7996 OXFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2241
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Country | US
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Telephone | 215-728-1411
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Fax | 215-745-7578
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Provider Business Mailing Address
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Address Line | 7996 OXFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2241
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Country | US
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Telephone | 215-728-1411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD065387L
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License Number State | PA
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