Individual
JOHN SCOTT STADALSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 SPRINGHALL DR, GOOSE CREEK, SC 29445-5370
(843) 766-6308
(866) 533-4473
Mailing address
1871 SAVAGE RD, CHARLESTON, SC 29407-4726
(843) 531-9961
(866) 533-4473
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24015
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571020809007
BCBS SC
SC
01
—
571020809042
TRICARE
SC
05
—
T83086
—
SC
Enumeration date
05/23/2006
Last updated
12/20/2019
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