Provider Demographics
NPI:1396709887
Name:STAGG, RICHARD D (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:STAGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 S FILBERT ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6539
Practice Address - Country:US
Practice Address - Phone:717-795-6656
Practice Address - Fax:717-795-6658
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046637L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016074660006Medicaid
PA151885OtherUNISON
PA1533511OtherGATEWAY
PA84931OtherGEISINGER
PA0016074660007Medicaid
PA30024886OtherKEYSTONE MERCY
PA50033281OtherCAPITAL BC
PAHIGHMARK BSOther000480988
PA30024886OtherKEYSTONE MERCY
PA0016074660006Medicaid
PA84931OtherGEISINGER