Provider Demographics
NPI:1700184108
Name:STACK, RICHARD SEAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SEAN
Last Name:STACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 RALEIGH RD STE 415
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8834
Mailing Address - Country:US
Mailing Address - Phone:919-883-3220
Mailing Address - Fax:
Practice Address - Street 1:1414 RALEIGH RD STE 415
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8834
Practice Address - Country:US
Practice Address - Phone:919-883-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25832207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology