Provider Demographics
NPI:1932119468
Name:STOKER, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:STOKER
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 1:342 VIRGINIA AVE
Mailing Address - Street 2:WYTHEVILLE
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1185
Mailing Address - Country:US
Mailing Address - Phone:276-228-2191
Mailing Address - Fax:276-228-2801
Practice Address - Street 1:342 VIRGINIA AVE
Practice Address - Street 2:WYTHEVILLE
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1185
Practice Address - Country:US
Practice Address - Phone:276-228-2191
Practice Address - Fax:276-228-2801
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101040987OtherVIRGINIA STATE MEDICAL LICENSE
VA00W966W06Medicare ID - Type Unspecified