Healthcare Provider Details

I. General information

NPI: 1346491677
Provider Name (Legal Business Name): STALIN CAMPOS FLORES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROLANDO STALIN CAMPOS FLORES MD

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NEW SCOTLAND AVE # MC53
ALBANY NY
12208-3403
US

IV. Provider business mailing address

50 NEW SCOTLAND AVE # MC53
ALBANY NY
12208-3403
US

V. Phone/Fax

Practice location:
  • Phone: 182-645-0455
  • Fax:
Mailing address:
  • Phone: 182-645-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD 431269
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-162494
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number102034
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number269696
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD431269
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: