Provider Demographics
NPI:1992913982
Name:JOHN G STAGIAS MD PC
Entity type:Organization
Organization Name:JOHN G STAGIAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR JOHN G STAGIAS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GUS
Authorized Official - Last Name:STAGIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-765-1600
Mailing Address - Street 1:428 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1859
Mailing Address - Country:US
Mailing Address - Phone:508-765-1600
Mailing Address - Fax:508-764-2502
Practice Address - Street 1:428 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1859
Practice Address - Country:US
Practice Address - Phone:508-765-1600
Practice Address - Fax:508-764-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80381207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA983813OtherNETWORK HEALTH
MAS029063OtherCHAMPUS
CT010080381MA01OtherANTHEM BCBS
MA452850OtherAETNA US HEALTHCARE
MA64553OtherHARVARD PILGRIM
MA080381OtherTUFTS
MA9773916Medicaid
MA21577OtherFALLON COM HEAOTH PLAN
MA33988OtherBMC
MAM16031OtherBCBS
MA080381OtherTUFTS
MA21577OtherFALLON COM HEAOTH PLAN