Provider Demographics
NPI:1003080318
Name:STAGLIANO, MICHAEL S (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:STAGLIANO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 HIALEAH WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3784
Mailing Address - Country:US
Mailing Address - Phone:650-690-0991
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR BLDG 10
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-3132
Practice Address - Country:US
Practice Address - Phone:240-507-0883
Practice Address - Fax:301-480-5598
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309096500Medicaid
AK247ZMedicare PIN