Provider Demographics
NPI:1316280043
Name:STUFFO, KATHRYN (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:STUFFO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1303 LIBERTY PL
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5710
Mailing Address - Country:US
Mailing Address - Phone:856-885-4584
Mailing Address - Fax:856-885-4896
Practice Address - Street 1:1303 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5710
Practice Address - Country:US
Practice Address - Phone:856-885-4584
Practice Address - Fax:856-885-4896
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016879208000000X
NJ25MB10125300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics