Provider Demographics
NPI:1336163765
Name:STANLEY, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:STANLEY
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 1:4100 WARRENSVILLE CENTER RD
Mailing Address - Street 2:STE 1002
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7024
Mailing Address - Country:US
Mailing Address - Phone:216-991-2600
Mailing Address - Fax:216-921-1389
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:STE 1002
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-991-2600
Practice Address - Fax:216-921-1389
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0035202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0696779Medicaid
P00066980OtherRR MEDICARE
OHA17325Medicare UPIN
P00066980OtherRR MEDICARE
OH0696779Medicaid