Stackhouse, Charles L

Stackhouse, Charles L is an sole proprietor health care provider with primary practice located at 4 Coulter Rd , Clifton Springs NY 14432-1122. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Stackhouse, Charles L can be contacted via phone (315) 462-2636.

Contact Information

Primary practice address
4 Coulter Rd Clifton Springs NY 14432-1122
Phone: (315) 462-2636
Fax: (315) 462-2638
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 143099 New York
Allopathic & Osteopathic Physicians / Surgery 208600000X 1430991 New York

Profile Details

NPI number 1932174497
LBN Legal business name Stackhouse, Charles L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 20th, 2006
Last updated Jun 13th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932174497 NPPES
New York MEDICAID 00835396

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