Provider Demographics
NPI:1417020660
Name:STAHL, SIMONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONNE
Middle Name:
Last Name:STAHL
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 1:8 PROSPECT ST
Mailing Address - Street 2:ADULT HOSPITALIST PROGRAM
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061
Mailing Address - Country:US
Mailing Address - Phone:603-577-2494
Mailing Address - Fax:
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:ADULT HOSPITALIST PROGRAM
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03061
Practice Address - Country:US
Practice Address - Phone:603-577-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209720207P00000X
NH13360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA195235OtherHPHC
MA110034753AMedicaid
NH30206476Medicaid
NH1417020660OtherANTHEM BCBS NH
NHAA195235OtherHPHC