Provider Demographics
NPI:1245219187
Name:STASIAK, JONI MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONI
Middle Name:MARIE
Last Name:STASIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644-9210
Mailing Address - Country:US
Mailing Address - Phone:330-863-9061
Mailing Address - Fax:330-863-6492
Practice Address - Street 1:635 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:OH
Practice Address - Zip Code:44644
Practice Address - Country:US
Practice Address - Phone:330-863-9061
Practice Address - Fax:330-863-6492
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00148632OtherRAILROAD MEDICARE
OH1389825OtherUNITED HEALTHCARE
OH000000210940OtherANTHEM BC BS
OH0187837Medicaid
OH1389825OtherUNITED HEALTHCARE
OH0187837Medicaid