Provider Demographics
NPI:1265499206
Name:STALLION, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:STALLION
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-403-2662
Mailing Address - Fax:704-403-2670
Practice Address - Street 1:100 MEDICAL PARK DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2966
Practice Address - Country:US
Practice Address - Phone:704-403-2662
Practice Address - Fax:704-403-2670
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060022S2086S0120X
NC2013-015422086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803198Medicaid
NC1265499206Medicaid
SCQ0154EMedicaid
OHST7343961Medicare PIN
NCNCF443AMedicare PIN
OHG45587Medicare UPIN