MEDICARE: STACEY LYNN MCCRACKEN RCP

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	227900000X	Registered Respiratory Therapist	LO1324	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LO1324	OTHER	MD	BPQA

General Provider Information

NPI Number	:	1427665272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LYNN MCCRACKEN RCP

Provider Business Mailing Address
First Line	:	2301 CEDLEY ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-3117
Country	:	US
Telephone Number	:	667-967-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CEDLEY ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-3117
Country	:	US
Telephone Number	:	667-967-0980
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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