Healthcare Provider Details

I. General information

NPI: 1326263807
Provider Name (Legal Business Name): ROBERT A STOLBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TETUAN 200
SAN JUAN PR
00901
US

IV. Provider business mailing address

TETUAN 200
SAN JUAN PR
00901
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3693
  • Fax:
Mailing address:
  • Phone: 787-724-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number5923
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: