Provider Demographics
NPI:1386703783
Name:STAZER, JULIE KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHRYN
Last Name:STAZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S JACKSON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3428
Mailing Address - Country:US
Mailing Address - Phone:412-734-7790
Mailing Address - Fax:412-734-7795
Practice Address - Street 1:100 S JACKSON AVE FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3428
Practice Address - Country:US
Practice Address - Phone:412-734-7790
Practice Address - Fax:412-734-7795
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023242340001Medicaid
PA157644NJKMedicare UPIN
PA157644NJKMedicare UPIN
TX174875801Medicaid
PA1023242340001Medicaid