Provider Demographics
NPI:1215073861
Name:STAGNONE, MARK WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:STAGNONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NASHUA RD
Mailing Address - Street 2:STE 106
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3400
Mailing Address - Country:US
Mailing Address - Phone:603-434-1236
Mailing Address - Fax:
Practice Address - Street 1:50 NASHUA RD
Practice Address - Street 2:STE 106
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3400
Practice Address - Country:US
Practice Address - Phone:603-434-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH108-1085A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNHRE2079Medicare ID - Type Unspecified