Individual
STACEY L ACKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1930 S BROAD ST UNIT 9, PHILADELPHIA, PA 19145-2328
(215) 339-8100
(215) 339-8103
Mailing address
1930 S BROAD ST UNIT 9, PHILADELPHIA, PA 19145-2328
(215) 339-8100
(215) 339-8103
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25MA04606000
NJ
207W00000X
Ophthalmology Physician
Primary
MD031968E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0903906
—
PA
Enumeration date
08/11/2005
Last updated
01/13/2020
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