Provider Demographics
NPI:1033229422
Name:ABBIS, STACEY ANN (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:ABBIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:GYNTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21 E HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2928
Mailing Address - Country:US
Mailing Address - Phone:603-577-4260
Mailing Address - Fax:603-577-4354
Practice Address - Street 1:21 E HOLLIS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2928
Practice Address - Country:US
Practice Address - Phone:603-577-4260
Practice Address - Fax:603-577-4354
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12330208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204493Medicaid
NHHX3604Medicare PIN
I10626Medicare UPIN