Healthcare Provider Details

I. General information

NPI: 1265580997
Provider Name (Legal Business Name): SCOTT ALAN STANEK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 LEESBURG PIKE SUITE 538
FALLS CHURCH VA
22041-3251
US

IV. Provider business mailing address

6649 DASHER CT
COLUMBIA MD
21045-8204
US

V. Phone/Fax

Practice location:
  • Phone: 703-681-3160
  • Fax:
Mailing address:
  • Phone: 410-381-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number02232
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: