Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 57.017204 | OH |
Y | 207N00000X | Dermatologist | MD449049 | PA |
NPI | 1053572420 |
---|---|
Provider Name | Dr. Joseph John Stuckert II |
First Address | Monroeville, PA 15146-2141 |
Second Address | Monroeville, PA 15146-2141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1028336330001 | (05) | PA |
2084307 | HIGHMARK (01) | PA |
4154419 | AETNA (01) | PA |