Healthcare Provider Details

I. General information

NPI: 1255313391
Provider Name (Legal Business Name): DAVID STAHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N MAIN ST
MIDDLEPORT NY
14105-1027
US

IV. Provider business mailing address

21 N MAIN ST
MIDDLEPORT NY
14105-1027
US

V. Phone/Fax

Practice location:
  • Phone: 716-735-7774
  • Fax: 716-735-3036
Mailing address:
  • Phone: 716-735-7774
  • Fax: 716-735-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number142618
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: