MEDICARE: DR. DAVID E STAPP MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01060245A	IN
2	207ZB0001X	Blood Banking & Transfusion Medicine Physician	01060245A	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000854062	OTHER	KY	ANTHEM
3	50065168	OTHER	KY	PASSPORT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1053343632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID E STAPP MD

Provider Business Mailing Address
First Line	:	1941 BISHOP LN STE 1018
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1928
Country	:	US
Telephone Number	:	502-456-6211
Fax Number	:	502-456-4440

Provider Business Practice Location Address
First Line	:	1850 STATE ST
Second Line	:	PATHOLOGY DEPT
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-4990
Country	:	US
Telephone Number	:	502-456-6211
Fax Number	:	502-456-4440

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/16/2026

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: