Provider Demographics
NPI:1376737262
Name:DAVID B. STOECKLE, M.D., P.A., P.C.
Entity Type:Organization
Organization Name:DAVID B. STOECKLE, M.D., P.A., P.C.
Other - Org Name:NEW RIVER SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:STOECKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-552-0005
Mailing Address - Street 1:820 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7023
Mailing Address - Country:US
Mailing Address - Phone:540-552-0005
Mailing Address - Fax:540-951-2215
Practice Address - Street 1:820 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7023
Practice Address - Country:US
Practice Address - Phone:540-552-0005
Practice Address - Fax:540-951-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7321643Medicaid
VA7321643Medicaid