Healthcare Provider Details

I. General information

NPI: 1154328672
Provider Name (Legal Business Name): TIMOTHY O STANLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SKIPWITH RD
RICHMOND VA
23229-5205
US

IV. Provider business mailing address

PO BOX 17978
RICHMOND VA
23226-7978
US

V. Phone/Fax

Practice location:
  • Phone: 804-289-4937
  • Fax: 804-565-6600
Mailing address:
  • Phone: 804-289-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101231144
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: