Provider Demographics
NPI:1508978875
Name:STANTON, HOWARD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:JAMES
Last Name:STANTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H JAMES
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4315 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2503
Mailing Address - Country:US
Mailing Address - Phone:304-926-8080
Mailing Address - Fax:304-926-8083
Practice Address - Street 1:4315 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2503
Practice Address - Country:US
Practice Address - Phone:304-926-8080
Practice Address - Fax:304-926-8083
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12013207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087346000Medicaid
WVP00058633OtherRAILROAD MEDICARE
A72307Medicare UPIN
WV0087346000Medicaid