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NPI Code Detail

MEDICARE: DR. CALVIN RANDOLPH STAFFORD JR. MD

MEDICARE: DR. CALVIN RANDOLPH STAFFORD JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology PhysicianMD013709EPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023014628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CALVIN RANDOLPH STAFFORD JR. MD
Provider Business Mailing Address
First Line : ONE MEDICAL CENTER BLVD
Second Line : SUITE 533
City : UPLAND
State : PA
Zip : 19013-3902
Country : US
Telephone Number : 610-874-1184
Fax Number : 610-874-4258
Provider Business Practice Location Address
First Line : ONE MEDICAL CENTER BLVD
Second Line : SUITE 533
City : UPLAND
State : PA
Zip : 19013-3902
Country : US
Telephone Number : 610-619-7475
Fax Number : 610-619-7477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 11/15/2012

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