| Dr William Lewis Stafford Jr, MD | |
|
85 N Grand Ave, Fort Thomas, KY 41075-1793 | |
| (859) 912-7211 | |
| (859) 655-6674 |
| Full Name | Dr William Lewis Stafford Jr |
|---|---|
| Gender | Male |
| Speciality | Family Medicine - Geriatric Medicine |
| Location | 85 N Grand Ave, Fort Thomas, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932287174 | NPI | - | NPPES |
| 64232176 | Medicaid | KY | |
| K070350 | Other | KY | KY MEDICARE |
| 2982812 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 23217 (Kentucky) | Secondary |
| 207QG0300X | Family Medicine - Geriatric Medicine | 23217 (Kentucky) | Primary |
| Entity Name | Summit Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508287640 PECOS PAC ID: 2163326240 Enrollment ID: O20031120000738 |
| Entity Name | St Elizabeth Medical Center, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932187937 PECOS PAC ID: 0648174623 Enrollment ID: O20031121000206 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr William Lewis Stafford Jr, MD Po Box 635283, Cincinnati, OH 45263-5446 Ph: (593) 445-5558 | Dr William Lewis Stafford Jr, MD 85 N Grand Ave, Fort Thomas, KY 41075-1793 Ph: (859) 912-7211 |
Dr. Erek Steven Majka, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 85 N Grand Ave, Fort Thomas, KY 41075 Phone: 859-301-4688 Fax: 859-301-2607 | |
Mara Tomaszewski, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 85 N Grand Ave, Fort Thomas, KY 41075 Phone: 859-912-7211 Fax: 859-655-6674 | |
Dr. Bahar Mittal, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 85 N Grand Ave, Fort Thomas, KY 41075 Phone: 859-912-7211 Fax: 859-655-6674 |