Provider Demographics
NPI:1134258379
Name:CHARLES W. STOTLER, M.D.
Entity type:Organization
Organization Name:CHARLES W. STOTLER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:STOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-266-8686
Mailing Address - Street 1:334 BLOOMFIELD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3268
Mailing Address - Country:US
Mailing Address - Phone:814-266-8686
Mailing Address - Fax:814-266-6478
Practice Address - Street 1:334 BLOOMFIELD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3268
Practice Address - Country:US
Practice Address - Phone:814-266-8686
Practice Address - Fax:814-266-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017069E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000746700003Medicaid
PA096835Medicare ID - Type Unspecified
PA000746700003Medicaid