Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD039841-L | PA |
NPI | 1033257407 |
---|---|
Provider Name | Dr. Stanley Michael Stanish |
First Address | Kingston, PA 18704-3831 |
Second Address | Kingston, PA 18704-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 17/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01026932 | (05) | PA |
C33136 | (02) | PA |