Provider Demographics
NPI:1023101169
Name:STAHL, BRIAN G (DPM)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:STAHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2690 KINGSTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8001
Practice Address - Country:US
Practice Address - Phone:610-438-8899
Practice Address - Fax:610-438-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004138L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00972929OtherRAILROAD MEDICARE
PA228701Medicare PIN
PAP00972929OtherRAILROAD MEDICARE
PAU65370Medicare UPIN