Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD042406E | PA |
N | 207NS0135X | Procedural Dermatology | MD042406E | PA |
NPI | 1376549360 |
---|---|
Provider Name | Dr. Michael B Stierstorfer |
First Address | North Wales, PA 19454-2532 |
Second Address | North Wales, PA 19454-2532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 09/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116203000010 | (05) | PA |
154144 | BLUE SHIELD (01) | PA |
2230872 | AETNA (01) | PA |
E12935 | (02) | PA |