Individual
LORI J STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-2730
(215) 590-4875
Mailing address
100 E PENN SQ, THE WANAMAKER BLDG. 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9538
(267) 425-9552
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD449411
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102873853-0001
—
PA
05
—
9780246
—
MA
Enumeration date
08/29/2006
Last updated
11/21/2018
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