Healthcare Provider Details

I. General information

NPI: 1538692611
Provider Name (Legal Business Name): RICHARD STANG RCS, RVS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 S BROAD ST
PHILADELPHIA PA
19148-4309
US

IV. Provider business mailing address

50 PINE ST
SEWELL NJ
08080-1450
US

V. Phone/Fax

Practice location:
  • Phone: 856-292-3884
  • Fax:
Mailing address:
  • Phone: 856-292-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: