Provider Demographics
NPI:1124011911
Name:STAMM, DAVID BRADLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRADLEY
Last Name:STAMM
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 1:201 SOUTH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-452-0696
Mailing Address - Fax:845-452-1839
Practice Address - Street 1:201 SOUTH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-452-0696
Practice Address - Fax:845-452-1839
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003132213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4800299003OtherMEDICARE RAILROAD
NY00547026Medicaid
NYP34121Medicare PIN
NY00547026Medicaid
NYP34122Medicare PIN
NYT51001Medicare UPIN