Healthcare Provider Details

I. General information

NPI: 1548309446
Provider Name (Legal Business Name): DAVID STAHL, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
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: DR. DAVID D STAHL
Title or Position: OWNER
Credential: MD
Phone: 716-735-7774