Active NPI
Dennis Clark Stanley, MD
- Diagnostic Radiology Physician
- South Boston, VA
National Provider Identifier
1700945763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 0101027902
- Practice address
- 2204 Wilborn Avenue
South Boston, VA 24592 - Phone
- (434) 517-3187
- Fax
- (434) 517-3686
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 0101027902 | VA | Primary |
Addresses
Primary practice location
2204 Wilborn Avenue
South Boston, VA 24592
Mailing address
PO Box 340
Halifax, VA 24558
Phone (434) 575-1683
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002596 | Other | BC | |
| 007242280 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287100800000",
"number": "1700945763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 340",
"city": "HALIFAX",
"state": "VA",
"postal_code": "24558",
"telephone_number": "434-575-1683",
"fax_number": "434-575-1682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2204 WILBORN AVENUE",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "24592",
"telephone_number": "434-517-3187",
"fax_number": "434-517-3686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "DENNIS",
"middle_name": "CLARK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2010-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "VA",
"license": "0101027902",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "002596",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007242280",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Boston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.