1023012424 NPI number — DR. JOHN GUS STAGIAS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023012424 NPI number — DR. JOHN GUS STAGIAS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

STAGIAS

Provider First Name:

JOHN

Provider Middle Name:

GUS

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1023012424

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/21/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 250

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

STURBRIDGE

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01566-0250

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-765-1600

Provider Business Mailing Address Fax Number:

508-765-0253

Provider First Line Business Practice Location Address:

428 HAMILTON ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SOUTHBRIDGE

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01550-1859

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-765-1600

Provider Business Practice Location Address Fax Number:

508-765-0253

Provider Enumeration Date:

06/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RG0100X , with the licence number:  80381 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 080381 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 64553 . This is a "HARVARD PILGLRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 110088781 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: S029063 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 33988 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 9773916 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: J14840 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 452850 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 983813 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 010080381MA01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 21577 . This is a "FALLON COM HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".