Healthcare Provider Details

I. General information

NPI: 1063734085
Provider Name (Legal Business Name): WILLIAM J STOCKTON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 HOWARD DR
PORT REPUBLIC MD
20676-2190
US

IV. Provider business mailing address

3405 HOWARD DR
PORT REPUBLIC MD
20676-2190
US

V. Phone/Fax

Practice location:
  • Phone: 443-295-7198
  • Fax: 443-295-7199
Mailing address:
  • Phone: 443-295-7198
  • Fax: 443-295-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberD0012330
License Number StateMD

VIII. Authorized Official

Name: DR. WILLIAM JAMES STOCKTON
Title or Position: OWNER
Credential: M.D.
Phone: 443-295-7198