Provider Demographics
NPI:1285810705
Name:DEMASCOLO, STACY L (MTBC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:L
Last Name:DEMASCOLO
Suffix:
Gender:F
Credentials:MTBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LOCUST LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4444
Mailing Address - Country:US
Mailing Address - Phone:717-526-2111
Mailing Address - Fax:717-526-2117
Practice Address - Street 1:4601 LOCUST LN
Practice Address - Street 2:SUITE 202
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4444
Practice Address - Country:US
Practice Address - Phone:717-526-2111
Practice Address - Fax:717-526-2117
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07431175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225A00000XMedicaid