Provider Demographics
NPI:1770571309
Name:STANLEY, STEPHEN ROBERT (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROBERT
Last Name:STANLEY
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:320 E 8TH ST
Practice Address - Street 2:SUITE 142
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3382
Practice Address - Country:US
Practice Address - Phone:740-373-4111
Practice Address - Fax:740-373-4860
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006980207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000511985OtherANTHEM
WV5630128000Medicaid
OHP00731312OtherRRMCR
OH2154225Medicaid
OH4094013Medicare PIN
OHP00731312OtherRRMCR