Provider Demographics
NPI:1023012424
Name:STAGIAS, JOHN GUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GUS
Last Name:STAGIAS
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-0250
Mailing Address - Country:US
Mailing Address - Phone:508-765-1600
Mailing Address - Fax:508-765-0253
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:508-765-0253
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80381207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
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MA983813OtherNETWORK HEALTH