Provider Demographics
NPI:1104036136
Name:STAHL, BRANDON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHRISTOPHER
Last Name:STAHL
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 1:16 LONG SANDS RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1147
Mailing Address - Country:US
Mailing Address - Phone:207-351-3975
Mailing Address - Fax:207-351-3923
Practice Address - Street 1:16 LONG SANDS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1147
Practice Address - Country:US
Practice Address - Phone:207-351-3975
Practice Address - Fax:207-351-3923
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7020208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME001263901Medicare PIN