Healthcare Provider Details

I. General information

NPI: 1700899317
Provider Name (Legal Business Name): STANLEY NATHAN CAROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE PHILADELPHIA VA MEDICAL CENTER
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

PHILADELPHIA VA MEDICAL CENTER 3900 WOODLAND AVE.
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-6270
  • Fax: 215-823-4267
Mailing address:
  • Phone: 215-823-6270
  • Fax: 215-823-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD022094E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: