Provider Demographics
NPI:1689269912
Name:CARY, STANLEY LOVETTE
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:LOVETTE
Last Name:CARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 ROSENBLUM CT APT 2D
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-0020
Mailing Address - Country:US
Mailing Address - Phone:804-921-9307
Mailing Address - Fax:
Practice Address - Street 1:6105 ROSENBLUM CT APT 2D
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-0020
Practice Address - Country:US
Practice Address - Phone:804-921-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT62519212172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver