Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101049205 | VA |
NPI | 1003843434 |
---|---|
Provider Name | Jack A Stabile |
First Address | Raleigh, NC 27616-2880 |
Second Address | Falls Church, VA 22042-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0061802000 | (05) | WV |
1003843434 | (05) | VA |
149801100 | (05) | MD |