Healthcare Provider Details

I. General information

NPI: 1073764056
Provider Name (Legal Business Name): DR. TOM ALEX STAMATIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3167
  • Fax: 330-375-6217
Mailing address:
  • Phone: 330-375-3043
  • Fax: 330-375-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35120582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: