Provider Demographics
NPI:1609028711
Name:DONNA LAURA STAHL, M.D., INC
Entity Type:Organization
Organization Name:DONNA LAURA STAHL, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-686-3109
Mailing Address - Street 1:4750 E GALBRAITH RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6705
Mailing Address - Country:US
Mailing Address - Phone:513-686-3109
Mailing Address - Fax:513-686-5903
Practice Address - Street 1:4750 E GALBRAITH RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6705
Practice Address - Country:US
Practice Address - Phone:513-686-3109
Practice Address - Fax:513-686-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH035743208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH035743OtherSTATE LICENSE
OH0375857Medicaid
OH0417555Medicare PIN
OH035743OtherSTATE LICENSE