Provider Demographics
NPI:1548309446
Name:DAVID STAHL, MD
Entity type:Organization
Organization Name:DAVID STAHL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-735-7774
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-1027
Mailing Address - Country:US
Mailing Address - Phone:716-735-7774
Mailing Address - Fax:716-735-3036
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1027
Practice Address - Country:US
Practice Address - Phone:716-735-7774
Practice Address - Fax:716-735-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00737173Medicaid
NY0401199OtherDAVE IH
NY005084881OtherDAVE WNY BC
NY9512794OtherMELANIE IH
NY00026799201OtherUNIVERA RONALD
NY000570073002OtherRON BS WNY
000570530001OtherMELANIE
NY00027023601OtherUNIVERA MELANIE
R70833Medicare UPIN
NYQ02097Medicare UPIN
NY000570073002OtherRON BS WNY
000570530001OtherMELANIE