Provider Demographics
NPI:1558685578
Name:STALDER, MARK WINSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WINSTON
Last Name:STALDER
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 1:6028 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5824
Mailing Address - Country:US
Mailing Address - Phone:504-800-8058
Mailing Address - Fax:504-387-6538
Practice Address - Street 1:6028 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5824
Practice Address - Country:US
Practice Address - Phone:504-800-8058
Practice Address - Fax:504-387-6538
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204793208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery