Provider Demographics
NPI:1063502433
Name:STANCLIFF, CHARLES DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:STANCLIFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 FULFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3813
Mailing Address - Country:US
Mailing Address - Phone:410-420-2801
Mailing Address - Fax:410-420-2803
Practice Address - Street 1:215 FULFORD AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3813
Practice Address - Country:US
Practice Address - Phone:410-420-2801
Practice Address - Fax:410-420-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU87701Medicare UPIN
MD170M176FMedicare ID - Type Unspecified