Provider Demographics
NPI:1770603672
Name:LENDENER, STACEY (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:LENDENER
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 1:1167 W BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5127
Mailing Address - Country:US
Mailing Address - Phone:610-328-1166
Mailing Address - Fax:610-328-2023
Practice Address - Street 1:900 OLD MARPLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1211
Practice Address - Country:US
Practice Address - Phone:610-328-1166
Practice Address - Fax:610-328-2023
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427274208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA180370ZEBMedicare PIN