Provider Demographics
NPI:1275846537
Name:BROWN, CHARLES STALNAKER (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STALNAKER
Last Name:BROWN
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Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2007
Practice Address - Country:US
Practice Address - Phone:570-271-6301
Practice Address - Fax:570-271-5976
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4567962085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program