1508978875 NPI number — HOWARD JAMES STANTON M.D.

Table of content: HOWARD JAMES STANTON M.D. (NPI 1508978875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508978875 NPI number — HOWARD JAMES STANTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANTON
Provider First Name:
HOWARD
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STANTON
Provider Other First Name:
H JAMES
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508978875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4315 MACCORKLE AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25304-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-926-8080
Provider Business Mailing Address Fax Number:
304-926-8083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 MACCORKLE AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-926-8080
Provider Business Practice Location Address Fax Number:
304-926-8083
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  12013 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207UN0901X , with the licence number: 12013 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0087346000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00058633 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".