Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD013709E | PA |
NPI | 1023014628 |
---|---|
Provider Name | Dr. Calvin Randolph Stafford JR. |
First Address | Upland, PA 19013-3902 |
Second Address | Upland, PA 19013-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0646325 | (05) | PA |
C32379 | (02) |