Provider Demographics
NPI:1356685119
Name:STAHL, CELINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CELINE
Middle Name:MARIE
Last Name:STAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PEMBERWICK RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5044
Mailing Address - Country:US
Mailing Address - Phone:203-622-8493
Mailing Address - Fax:
Practice Address - Street 1:84 PEMBERWICK RD
Practice Address - Street 2:UNIT A
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5044
Practice Address - Country:US
Practice Address - Phone:203-622-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030326174400000X
NY150281-1174400000X
CAG47410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty