Provider Demographics
NPI:1417173659
Name:RHODES, STANCIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:STANCIE
Middle Name:C
Last Name:RHODES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:STANCIE
Other - Middle Name:CHRISTINA
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:908-202-6942
Mailing Address - Fax:
Practice Address - Street 1:1 SPRINGFIELD AVENUE
Practice Address - Street 2:SUITE 3A
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-202-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065118208600000X
DCMD036519208600000X
NJ25MA08753400208600000X
SCTL38211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00883890OtherRR MCR PTAN
NJP01117753OtherRAILROAD MEDICARE
NJ0237353Medicaid
NJP00883890OtherRR MCR PTAN
NJ189866NAHMedicare PIN