1164268165 NPI number — OLDE TOWNE MEDICAL PRACTICE PLLC

Table of content: DR. AARON MICHAEL STUTZ M.D. (NPI 1174851901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164268165 NPI number — OLDE TOWNE MEDICAL PRACTICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLDE TOWNE MEDICAL PRACTICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164268165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 GOODE WAY STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23704-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-399-0701
Provider Business Mailing Address Fax Number:
757-399-3731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 GOODE WAY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23704-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-399-0701
Provider Business Practice Location Address Fax Number:
757-399-3731
Provider Enumeration Date:
07/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
LATISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE BILLING CLERK
Authorized Official Telephone Number:
757-399-0701

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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