MEDICARE: DR. MARY JOANNE BERNADETTE STALLMEYER MD, PHD

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	2085N0700X	Neuroradiology Physician	D0052263	MD
2	2085N0700X	Neuroradiology Physician	MD441979	PA
3	2085R0202X	Diagnostic Radiology Physician	D0052263	MD
4	2085R0204X	Vascular & Interventional Radiology Physician	D0052263	MD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	967707	OTHER	MD	AETNA HMO
5	3811 0020	OTHER	DC	CAREFIRST BCBS DC
6	5235541	OTHER	MD	AETNA PPO
7	KC46SH	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1710979067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOANNE BERNADETTE STALLMEYER MD, PHD

Provider Business Mailing Address
First Line	:	6TH AVENUE & SPRUCE STREET
Second Line	:
City	:	WEST READING
State	:	PA
Zip	:	19611-1428
Country	:	US
Telephone Number	:	610-988-8059
Fax Number	:	610-988-4242

Provider Business Practice Location Address
First Line	:	6TH AVENUE & SPRUCE STREET
Second Line	:
City	:	WEST READING
State	:	PA
Zip	:	19611-1428
Country	:	US
Telephone Number	:	610-988-8059
Fax Number	:	610-988-4242

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	09/12/2012

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