Provider Demographics
NPI:1538692611
Name:STANG, RICHARD (RCS, RVS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STANG
Suffix:
Gender:M
Credentials:RCS, RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1450
Mailing Address - Country:US
Mailing Address - Phone:856-292-3884
Mailing Address - Fax:
Practice Address - Street 1:2511 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4309
Practice Address - Country:US
Practice Address - Phone:856-292-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist