Basic Information
| Provider Information | |||||||||
| NPI: | 1508884222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GETZ | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602478 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044466810 | ||||||||
| FaxNumber: | 7043760805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 MOREHEAD MEDICAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044466810 | ||||||||
| FaxNumber: | 7043760805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 34322 | NC | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0099X | 34322 | NC | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2086S0122X | 34322 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 208600000X | 34322 | NC | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1508884222 | 05 | NC | MEDICAID | 3512X | 01 | NC | NCBCBS | OTHER | 893512X | 05 | NC | MEDICAID | N34322 | 05 | SC | MEDICAID |