MEDICARE: ROBERT CHARLES STANLEY D.O.

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
1	207Q00000X	Family Medicine Physician	1039	WV

Other Identifiers

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

General Provider Information

NPI Number	:	1023122041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHARLES STANLEY D.O.

Provider Business Mailing Address
First Line	:	702 PROFESSIONAL PARK DR
Second Line	:	SUITE 100
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2018
Country	:	US
Telephone Number	:	304-872-2991
Fax Number	:	304-872-6268

Provider Business Practice Location Address
First Line	:	702 PROFESSIONAL PARK DR
Second Line	:	SUITE 100
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2018
Country	:	US
Telephone Number	:	304-872-2991
Fax Number	:	304-872-6268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/01/2010

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