Provider Demographics
NPI:1063734085
Name:WILLIAM J STOCKTON, M.D.
Entity type:Organization
Organization Name:WILLIAM J STOCKTON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-295-7198
Mailing Address - Street 1:3405 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-2190
Mailing Address - Country:US
Mailing Address - Phone:443-295-7198
Mailing Address - Fax:443-295-7199
Practice Address - Street 1:3405 HOWARD DR
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:MD
Practice Address - Zip Code:20676-2190
Practice Address - Country:US
Practice Address - Phone:443-295-7198
Practice Address - Fax:443-295-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012330261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF88142Medicare PIN