Basic Information
| Provider Information | |||||||||
| NPI: | 1124260872 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PETER R. STAHL, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 TITUS AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146173535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852660540 | ||||||||
| FaxNumber: | 5853429566 | ||||||||
| Practice Location | |||||||||
| Address1: | 485 TITUS AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146173535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852660540 | ||||||||
| FaxNumber: | 5853429566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2009 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | STAHL | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 5852660540 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 106640 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.