MEDICARE: BRANDON CHRISTOPHER STAHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	R-7020	IA

General Provider Information

NPI Number	:	1104036136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON CHRISTOPHER STAHL M.D.

Provider Business Mailing Address
First Line	:	16 LONG SANDS RD
Second Line	:
City	:	YORK
State	:	ME
Zip	:	03909-1147
Country	:	US
Telephone Number	:	207-351-3975
Fax Number	:	207-351-3923

Provider Business Practice Location Address
First Line	:	16 LONG SANDS RD
Second Line	:
City	:	YORK
State	:	ME
Zip	:	03909-1147
Country	:	US
Telephone Number	:	207-351-3975
Fax Number	:	207-351-3923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/06/2012

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