Provider Demographics
NPI:1477628667
Name:STILLERMAN, CHARLES BLAIR (MD, FACS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BLAIR
Last Name:STILLERMAN
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Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:310 MADISON AVENUE SUITE 300
Mailing Address - Street 2:ATLANTIC NEUROSURGICAL SPECIALTS
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6967
Mailing Address - Country:US
Mailing Address - Phone:973-285-7800
Mailing Address - Fax:973-285-7805
Practice Address - Street 1:310 MADISON AVENUE SUITE 300
Practice Address - Street 2:ATLANTIC NEUROSURGICAL SPECIALTS
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6967
Practice Address - Country:US
Practice Address - Phone:973-285-7800
Practice Address - Fax:973-285-7805
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-11-23
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA 08659500207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0289043Medicaid
E33435Medicare UPIN
NJ0289043Medicaid