Individual
JOHN PATRICK STOUTENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 PARK ST, CR WOOD CANCER CENTER, GLENS FALLS, NY 12801-4413
(518) 926-6620
(518) 926-1954
Mailing address
100 PARK STREET, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-5924
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
225232
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02667792
—
NY
01
—
P00248124
RR MEDICARE
NY
Enumeration date
10/12/2005
Last updated
06/29/2021
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