Provider Demographics
NPI:1932191020
Name:BYLCIW, STANLEY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ROBERT
Last Name:BYLCIW
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 1:540 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4016
Mailing Address - Country:US
Mailing Address - Phone:919-934-1094
Mailing Address - Fax:919-934-9044
Practice Address - Street 1:540 NORTH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4016
Practice Address - Country:US
Practice Address - Phone:919-934-1094
Practice Address - Fax:919-934-9044
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26207207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890181AMedicaid
NC890181AMedicaid
C87430Medicare UPIN