Individual
STACEY M KASSUTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BLVD FL 1, PHILADELPHIA, PA 19104-5161
(215) 662-3202
(215) 349-8432
Mailing address
3400 CIVIC CENTER BLVD FL 1, PHILADELPHIA, PA 19104-5161
(215) 662-3202
(215) 349-8432
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD447429
PA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD447429
PA
207RP1001X
Pulmonary Disease Physician
MD447429
PA
Other
Enumeration date
04/28/2010
Last updated
10/14/2019
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