Healthcare Provider Details

I. General information

NPI: 1346359858
Provider Name (Legal Business Name): STANLEY L. GARBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILLICOTHE VA MEDICAL CENTER 17273 ST. TR. 104
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

3119 WINDING WAY
KETTERING OH
45419-1245
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 937-299-3944
  • Fax: 740-772-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35 023660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: