Provider Demographics
NPI:1962473579
Name:STAHL, LOREN C (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:C
Last Name:STAHL
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 1:618 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2057
Mailing Address - Country:US
Mailing Address - Phone:478-745-1191
Mailing Address - Fax:478-750-4669
Practice Address - Street 1:618 ORANGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2057
Practice Address - Country:US
Practice Address - Phone:478-745-1191
Practice Address - Fax:478-750-4669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00224188AMedicaid
GAB98273Medicare UPIN