Provider Demographics
NPI:1235107541
Name:STAVIS, DONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:STAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 ROBINSON AVE
Mailing Address - Street 2:C/O ORANGE RADIOLOGY ASSOCIATES, P.C.
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3353
Mailing Address - Country:US
Mailing Address - Phone:845-565-1989
Mailing Address - Fax:845-863-0072
Practice Address - Street 1:320 ROBINSON AVE
Practice Address - Street 2:C/O ORANGE RADIOLOGY ASSOCIATES, PC
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3353
Practice Address - Country:US
Practice Address - Phone:845-565-1989
Practice Address - Fax:845-863-0072
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1238042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01433563Medicaid
NYP00330504OtherRAILROAD MEDICARE
NYP00330504OtherRAILROAD MEDICARE
NY71F461Medicare ID - Type Unspecified