Basic Information
| Provider Information | |||||||||
| NPI: | 1881625374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERT | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | GAUTHIER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512521 | ||||||||
| FaxNumber: | 7178513535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | BLDG MKB | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512521 | ||||||||
| FaxNumber: | 7178513535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD417684 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100475 | 01 | PA | GEISINGER | OTHER | 03276101 | 01 | PA | CAPITAL BLUE CROSS-YH | OTHER | 104601 | 01 | PA | JOHNS HOPKINS | OTHER | 114517 | 01 | PA | UNISON-YH | OTHER | 080188900 | 01 | PA | RAILROAD MEDICARE | OTHER | 20015676 | 01 | PA | AMERIHEALTH MERCY-YH | OTHER | P004686 | 01 | PA | GATEWAY-YH | OTHER | 2076681000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 282977 | 01 | PA | MAMSI-YH | OTHER | 7300892 | 01 | PA | AETNA | OTHER | 001894990 | 05 | PA | MEDICAID | 1386785 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 615817 | 01 | MD | CAREFIRST MD BCBS | OTHER |