MEDICARE: DR. CHRISTINA STASIUK 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	207R00000X	Internal Medicine Physician	OS006477E	PA

General Provider Information

NPI Number	:	1033542527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA STASIUK D.O.

Provider Business Mailing Address
First Line	:	753 N 26TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CHESTNUT ST
Second Line	:	2 LIBERTY PLACE TL08F
City	:	PHILADELPHIA
State	:	PA
Zip	:	19192-0003
Country	:	US
Telephone Number	:	215-761-7168
Fax Number	:

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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