Provider Demographics
NPI:1962500983
Name:STAHL, GARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:SUITE 755 DORRANCE
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2265
Practice Address - Fax:856-342-8007
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-021268-E208000000X, 2080N0001X
NJMA59353208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2969173OtherAETNA
NJ439606OtherUNITED HEALTHCARE
NJP746135OtherOXFORD
NJCA0000015OtherAMERICHOICE
NJ0048741000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3K5977OtherHEALTHNET, INC
NJ9023995OtherCIGNA
NJ0262307Medicaid
NJ25011OtherUNIVERSITY HEALTH PLAN
NJ1010670OtherHORIZON NJ HEALTH
NJ903661 / 000199OtherAMERIHEALTH PPO/ PA BS
NJCA0000015OtherAMERICHOICE
NJ903661 / 000199OtherAMERIHEALTH PPO/ PA BS