Provider Demographics
NPI:1407841190
Name:STAMBAUGH, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:STAMBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-848-7374
Practice Address - Fax:856-848-5855
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063183002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ29882OtherUNIV. HLTH PL. PROVIDER #
NJ2K7309OtherHEALTH NET PROVIDER #
NJ3644795OtherAETNA PROVIDER NUMBER
NJ4099456OtherGHI PROVIDER NUMBER
NJ65068OtherAMERIGROUP PROVIDER #
NJP00179698OtherRAILROAD MCARE PROV. #
NJP2364047OtherOXFORD HEALTH PROV. #
NJ0268865000OtherAMERIHEALTH PROVIDER #
NJ7831005Medicaid
NJ01000343204OtherAMERICHOICE-WILLINGBORO #
NJ01000343202OtherAMERICHOICE - VORHEES #
NJ01000343203OtherAMERICHOICE - WOODBURY #
NJ60016956OtherHORIZON NJ HEALTH PROV. #
NJ3774564OtherCIGNA PROVIDER NUMBER
NJ2K7309OtherHEALTH NET PROVIDER #
NJ3644795OtherAETNA PROVIDER NUMBER