Healthcare Provider Details
I. General information
NPI: 1962500983
Provider Name (Legal Business Name): GARY E STAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/21/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 COOPER PLZ SUITE 755 DORRANCE
CAMDEN NJ
08103-1461
US
IV. Provider business mailing address
3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US
V. Phone/Fax
- Phone: 856-342-2265
- Fax: 856-342-8007
- Phone: 856-968-7433
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | MD-021268-E |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | MA59353 |
| License Number State | NJ |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | MD-021268-E |
| License Number State | PA |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | MA59353 |
| License Number State | NJ |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 2969173 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA |
| # 2 | |
| Identifier | 439606 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | UNITED HEALTHCARE |
| # 3 | |
| Identifier | P746135 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | OXFORD |
| # 4 | |
| Identifier | CA0000015 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERICHOICE |
| # 5 | |
| Identifier | 0048741000 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERIHEALTH/KEYSTONE/IBC |
| # 6 | |
| Identifier | 3K5977 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | HEALTHNET, INC |
| # 7 | |
| Identifier | 9023995 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | CIGNA |
| # 8 | |
| Identifier | 0262307 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 9 | |
| Identifier | 25011 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | UNIVERSITY HEALTH PLAN |
| # 10 | |
| Identifier | 1010670 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | HORIZON NJ HEALTH |
| # 11 | |
| Identifier | 903661 / 000199 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERIHEALTH PPO/ PA BS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
