Provider Demographics
NPI:1346246428
Name:STILLMAN, ELWIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELWIN
Middle Name:L
Last Name:STILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7785 N STATE ST
Mailing Address - Street 2:STE 330
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5469
Mailing Address - Fax:315-376-6696
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:STE 330
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5469
Practice Address - Fax:315-376-6696
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00556038Medicaid
NY31842AMedicare PIN
NYP00883772Medicare PIN
NYB79358Medicare UPIN
NYJ400026882Medicare PIN
NY31842BMedicare PIN