Individual
DR. COLIN DANIEL STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ONE MEDICAL CENTER DRIVE, EMERGENCY MEDICINE, LEBANON, NH 03756-0001
(603) 650-7254
Mailing address
ONE MEDICAL CENTER DRIVE, EMERGENCY MEDICINE, LEBANON, NH 03756-0001
(603) 650-7254
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19481
NH
207P00000X
Emergency Medicine Physician
239371
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035907
—
VT
05
—
3116463
—
NH
Enumeration date
06/30/2008
Last updated
05/20/2019
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