| Doctor Name: | JASON CHARLES STANFORD |
| NPI Number: | 1003093667 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C |
| License Number: | C0002208 |
| Business Practice Address: | 19466 Caravan Dr Germantown, MD - 208746220 |
| Business Phone Number: | 3015280868 |
| Business Fax Number: | |
| Mailing Address: | 19466 Caravan Dr, GERMANTOWN |
| State: | MD |
| Postal Code: | 208746220 |
| Phone Number: | 3015280868 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2008 |
| NPI Last Update Date: | 01/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | C0002208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |