Provider Demographics
NPI:1154571305
Name:GROSS, STACI H (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:H
Last Name:GROSS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2494 BERNVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9469
Mailing Address - Country:US
Mailing Address - Phone:610-378-2499
Mailing Address - Fax:610-378-2989
Practice Address - Street 1:2494 BERNVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9469
Practice Address - Country:US
Practice Address - Phone:610-378-2499
Practice Address - Fax:610-378-2989
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2015-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical