Healthcare Provider Details

I. General information

NPI: 1144201278
Provider Name (Legal Business Name): EDWARD SPIRES STANTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARH LANE SUITE 202B
LOW MOOR VA
24457
US

IV. Provider business mailing address

1 ARH LANE SUITE 202B
LOW MOOR VA
24457
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-7181
  • Fax:
Mailing address:
  • Phone: 540-862-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27858
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number061521
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101236472
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: