Provider Demographics
NPI:1457307274
Name:STANISLAW, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:STANISLAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SHARON AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4326
Mailing Address - Country:US
Mailing Address - Phone:828-758-7091
Mailing Address - Fax:828-758-7058
Practice Address - Street 1:232 SHARON AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4326
Practice Address - Country:US
Practice Address - Phone:828-758-7091
Practice Address - Fax:828-758-7058
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601078207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979408Medicaid
NC8979408Medicaid
NC229874CMedicare ID - Type Unspecified