Healthcare Provider Details

I. General information

NPI: 1831136704
Provider Name (Legal Business Name): ANDREW P STALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 DRESSLER RD NW STE 100
CANTON OH
44718-2784
US

IV. Provider business mailing address

PO BOX 35006
CANTON OH
44735-5006
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-2097
  • Fax: 330-494-9750
Mailing address:
  • Phone: 330-494-2097
  • Fax: 330-494-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number35078915
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35078915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: