Provider Demographics
NPI:1194504100
Name:JOSEPH J STUCKERT II MD LLC
Entity type:Organization
Organization Name:JOSEPH J STUCKERT II MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STUCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-730-2900
Mailing Address - Street 1:9365 MCKNIGHT RD STE 700
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5955
Mailing Address - Country:US
Mailing Address - Phone:412-730-2900
Mailing Address - Fax:412-452-9698
Practice Address - Street 1:9365 MCKNIGHT RD STE 700
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5955
Practice Address - Country:US
Practice Address - Phone:412-730-2900
Practice Address - Fax:412-452-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD449049OtherPENNSYLVANIA DEPARTMENT OF STATE - BOARD OF PROFESSIONAL LICENSING