1932394376 NPI number — STADELMANN CENTER FOR PLASTIC SURGERY, P.C.

Table of content: (NPI 1932394376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932394376 NPI number — STADELMANN CENTER FOR PLASTIC SURGERY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STADELMANN CENTER FOR PLASTIC SURGERY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932394376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-224-5200
Provider Business Mailing Address Fax Number:
603-224-5091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-2588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-224-5200
Provider Business Practice Location Address Fax Number:
603-224-5091
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STADELMANN
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-224-5200

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  11822 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RE7067 . This is a "MEDICARE INDIVIDUAL PROV#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: RE7068 . This is a "MEDICARE GROUP PROV#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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