Provider Demographics
NPI:1730404609
Name:STAHL, BENJAMIN ADAM
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ADAM
Last Name:STAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CROSS ROADS PLZ
Mailing Address - Street 2:K-MART PHARMACY
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2287
Mailing Address - Country:US
Mailing Address - Phone:724-547-0535
Mailing Address - Fax:
Practice Address - Street 1:100 CROSS ROADS PLZ
Practice Address - Street 2:K-MART PHARMACY
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2287
Practice Address - Country:US
Practice Address - Phone:724-547-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI109789390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program