Provider Demographics
NPI:1194797183
Name:ARCHER, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 WASHINGTON AVE
Mailing Address - Street 2:SUITE C, SECOND FLOOR
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:391 WASHINGTON AVE
Practice Address - Street 2:SUITE C, SECOND FLOOR
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1739
Practice Address - Country:US
Practice Address - Phone:412-826-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065933L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001706769Medicaid
PA018402PD8Medicare ID - Type Unspecified
PAG80139Medicare UPIN