Provider Demographics
NPI:1417070640
Name:M ALEXANDER STATON MD PA
Entity Type:Organization
Organization Name:M ALEXANDER STATON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-448-2824
Mailing Address - Street 1:1601 N OAK ST
Mailing Address - Street 2:SUITE 206 MYRTLE OFFICES
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3579
Mailing Address - Country:US
Mailing Address - Phone:843-448-2824
Mailing Address - Fax:
Practice Address - Street 1:1601 N OAK ST
Practice Address - Street 2:SUITE 206 MYRTLE OFFICES
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3579
Practice Address - Country:US
Practice Address - Phone:843-448-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1990Medicare PIN