MEDICARE: DR. MICHAEL B STIERSTORFER M.D.

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	207NS0135X	Procedural Dermatology Physician	MD042406E	PA
2	207N00000X	Dermatology Physician	MD042406E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	154144	OTHER	PA	BLUE SHIELD
3	2230872	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1376549360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL B STIERSTORFER M.D.

Provider Business Mailing Address
First Line	:	311 N SUMNEYTOWN PIKE
Second Line	:	STE 1E
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:	215-661-0300
Fax Number	:	215-661-0302

Provider Business Practice Location Address
First Line	:	311 N SUMNEYTOWN PIKE
Second Line	:	STE 1E
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:	215-699-1929
Fax Number	:	215-661-0302

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/22/2022

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