Individual
NORMAN RUSSELL STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
9131 PISCATAWAY RD, SUITE 600, CLINTON, MD 20735-2508
(301) 868-0110
(301) 856-0604
Mailing address
9131 PISCATAWAY RD, SUITE 600, CLINTON, MD 20735-2508
(301) 868-0110
(301) 856-0604
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0000861
MD
Other
Enumeration date
09/26/2006
Last updated
07/09/2007
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