Healthcare Provider Details

I. General information

NPI: 1245329622
Provider Name (Legal Business Name): KATHERINE L STAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 TROY SCHENECTADY RD SUITE 215
LATHAM NY
12110-2490
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 203
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-713-5347
  • Fax: 518-713-5359
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number211086
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number211086
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: