Provider Demographics
NPI:1861408957
Name:STACHEL, DAVID CRAIG (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CRAIG
Last Name:STACHEL
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 1:1445 HARRISON AVE NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2628
Mailing Address - Country:US
Mailing Address - Phone:330-458-3260
Mailing Address - Fax:330-458-3263
Practice Address - Street 1:1445 HARRISON AVE NW
Practice Address - Street 2:SUITE 202
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2628
Practice Address - Country:US
Practice Address - Phone:330-458-3260
Practice Address - Fax:330-458-3263
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882899Medicaid
A16897Medicare UPIN
OH0882899Medicaid