Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | MA46176 | NJ |
NPI | 1578659082 |
---|---|
Provider Name | Dr. Thomas G Stackhouse |
First Address | Marlton, NJ 08053-3195 |
Second Address | Voorhees, NJ 08043-9623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 23/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0065218 | GHI (01) | NJ |
0090628000 | AMERIHEALTH (01) | NJ |
0090628000 | KEYSTONE (01) | NJ |
1243672 | UNITED HEALTHCARE (01) | NJ |
157012 | GREAT WEST (01) | NJ |
2K1291 | HEALTHNET (01) | NJ |
3730395B | CIGNA (01) | NJ |
4090523 | AETNA (01) | NJ |
6569F02206 | 1ST OPTION (01) | NJ |
BNS012 | OXFORD (01) | NJ |
C59136 | (02) | NJ |