Provider Demographics
NPI:1396702437
Name:TAO, STANLEY S (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:TAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 ALPHARETTA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3805
Mailing Address - Country:US
Mailing Address - Phone:404-596-5670
Mailing Address - Fax:
Practice Address - Street 1:11650 ALPHARETTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3805
Practice Address - Country:US
Practice Address - Phone:404-596-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2265150Medicaid
WV1699732214OtherGROUP NPI
WV180621000Medicaid
WVH38239Medicare UPIN
WV180621000Medicaid
WV0374350001Medicare NSC
OHTA4051922Medicare PIN