Provider Demographics
NPI:1780797563
Name:STALLINGS, WILLIAM HENRY JR (RD LDN CSSD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:STALLINGS
Suffix:JR
Gender:M
Credentials:RD LDN CSSD
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Mailing Address - Street 1:2824 COTTMAN AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1400
Mailing Address - Country:US
Mailing Address - Phone:215-333-6126
Mailing Address - Fax:215-333-6127
Practice Address - Street 1:2824 COTTMAN AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1400
Practice Address - Country:US
Practice Address - Phone:215-333-6126
Practice Address - Fax:215-333-6127
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-12-06
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Provider Licenses
StateLicense IDTaxonomies
PADN002543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered