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General NPI Number Information
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NPI Number | 1841227089
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Entity Type | Individual
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Provider Name | EDWARD STACHOWIAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | ROUTES 940 & 115
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City | BLAKESLEE
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State | PA
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Zip | 18610
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Country | US
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Telephone | 570-646-8745
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Fax | 570-646-8962
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Provider Business Mailing Address
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Address Line | 610 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3702
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Country | US
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Telephone | 570-288-5441
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Fax | 570-288-5842
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD044630L
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License Number State | PA
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