Provider Demographics
NPI:1083662084
Name:STAHL, JOHN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1331 N ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331 N ELM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6302
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC362742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79308OtherBCBS
NC8979308Medicaid
NC13463OtherPARTNERS
NC1607872OtherUNITED HEALTHCARE
NC300093747OtherRAILROAD MEDICARE
VA1083662084Medicaid
NC86455OtherMEDCOST
NCG07253Medicare UPIN
NC2214658BMedicare ID - Type Unspecified