Individual
STACY L GITTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
5855 BREMO RD, SUITE 406, RICHMOND, VA 23226-1930
(804) 285-4133
(804) 622-2224
Mailing address
5855 BREMO RD, SUITE 406, RICHMOND, VA 23226-1930
(804) 285-4133
(804) 622-2224
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110002656
VA
363AS0400X
Surgical Physician Assistant
MA052610
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06695
GROUP PTAN
VA
01
—
C06778
GROUP PTAN
VA
Enumeration date
08/03/2006
Last updated
03/12/2012
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