# JOHN SCOTT STADALSKY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1699720250
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 24015 | SC | Yes |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 12/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 571020809007 | BCBS SC | SC |
| 01 | — | 571020809042 | TRICARE | SC |
| 05 | — | T83086 | — | SC |