Provider Demographics
NPI:1538109376
Name:STAVIN, HALINA (MD)
Entity Type:Individual
Prefix:
First Name:HALINA
Middle Name:
Last Name:STAVIN
Suffix:
Gender:F
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:PO BOX 3308
Mailing Address - Street 2:TROY ANESTHESIOLOGISTS, PC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3308
Mailing Address - Country:US
Mailing Address - Phone:866-868-8419
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:SAMARITAN HOSPITAL
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3258
Practice Address - Fax:518-271-3208
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165896-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00964521Medicaid
NY56454FMedicare ID - Type Unspecified
NY00964521Medicaid