Healthcare Provider Details

I. General information

NPI: 1649353624
Provider Name (Legal Business Name): STUART M KILSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WARWICK BLVD STE 290
NEWPORT NEWS VA
23601-2344
US

IV. Provider business mailing address

1 EDGEWATER ST
STATEN ISLAND NY
10305-4907
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5454
  • Fax:
Mailing address:
  • Phone: 718-226-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25MA06661300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME0070480
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number15204L
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101271302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: