Individual
STACEY J.P. MEMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4015 MEDINA RD STE 50, MEDINA, OH 44256-5970
(330) 723-7005
(330) 723-4854
Mailing address
PO BOX 8792, BELFAST, ME 04915-8792
(300) 723-7005
(330) 723-4854
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35077164
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2196565
—
OH
Enumeration date
09/16/2006
Last updated
07/26/2011
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