Provider Demographics
NPI:1487908802
Name:ROBERT J. STALLONE M.D., INC.
Entity type:Organization
Organization Name:ROBERT J. STALLONE M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-549-9192
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE 622
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2190
Mailing Address - Country:US
Mailing Address - Phone:510-549-9192
Mailing Address - Fax:510-549-9193
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 622
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-549-9192
Practice Address - Fax:510-549-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty