Organization
CHARLES W. STOTLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN M SYBERT CMA (BILLING COORDINATOR)
(814) 736-9628
Entity
Organization
Contact information
Practice address
711 CALDWELL AVE, PORTAGE, PA 15946-1557
(814) 736-9628
(814) 736-3797
Mailing address
711 CALDWELL AVE, PORTAGE, PA 15946-1557
(814) 736-9628
(814) 736-3797
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
017069E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007466700002
—
PA
Enumeration date
04/23/2009
Last updated
04/23/2009
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