=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033865878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD RUSSEL STANSKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2022
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 ASHFIELD ROAD
-----------------------------------------------------
City | ATHERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-344-9866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 ASHFIELD ROAD
-----------------------------------------------------
City | ATHERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-344-9866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Pharmacology Physician
-----------------------------------------------------
License Number | G31586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------