Provider Demographics
NPI:1215979570
Name:FACCHINA, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:FACCHINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11896 BUCHANAN TRL W
Mailing Address - Street 2:
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-9767
Mailing Address - Country:US
Mailing Address - Phone:717-498-0383
Mailing Address - Fax:717-498-0379
Practice Address - Street 1:11896 BUCHANAN TRL W
Practice Address - Street 2:
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-9767
Practice Address - Country:US
Practice Address - Phone:717-498-0383
Practice Address - Fax:717-498-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64722207W00000X
PAMD429234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404603000Medicaid
MDP00349030OtherRAILROAD MEDICARE
PA0015389300009Medicaid
PA1016784980002Medicaid
MD411245800Medicaid
PAP00342706OtherRAILROAD MEDICARE
MD411245800Medicaid
PA1016784980002Medicaid
I02820Medicare UPIN
MD404603000Medicaid