Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 01330 | MD |
Y | 222Z00000X | Podiatrist | 01330 | MD |
NPI | 1063502433 |
---|---|
Provider Name | Dr. Charles David Stancliff |
First Address | Bel Air, MD 21014-3813 |
Second Address | Bel Air, MD 21014-3813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U87701 | (02) | MD |