Individual
DR. CHARLES L STACKHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 COULTER RD, CLIFTON SPRINGS, NY 14432-1122
(315) 462-2636
(315) 462-2638
Mailing address
4567 CROSSROADS PARK DR, LIVERPOOL, NY 13088-3589
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
143099
NY
208600000X
Surgery Physician
Primary
1430991
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00835396
—
NY
Enumeration date
02/20/2006
Last updated
06/13/2013
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