Provider Demographics
NPI:1942730957
Name:STAMM, DOUGLAS ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:STAMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2262
Mailing Address - Country:US
Mailing Address - Phone:144-453-5758
Mailing Address - Fax:
Practice Address - Street 1:329 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2262
Practice Address - Country:US
Practice Address - Phone:144-453-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine