Provider Demographics
NPI:1497862742
Name:STAWASZ, DONNA M (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:STAWASZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:655 MAIN ST
Mailing Address - Street 2:SACO VA CLINIC
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1543
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-286-3709
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:SACO VA CLINIC
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1543
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-286-3709
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-01-28
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Provider Licenses
StateLicense IDTaxonomies
ME017029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0103961YPMA02OtherANTHEM NEW HAMPSHIRE
5456642OtherAETNA (PPO)
A28890OtherHARVARD PILGRIM HEALTHCAR
100312OtherANTHEM MAINE
CIGNAOther6985496
1217615OtherAETNA (HMO)
CIGNAOther6985496
1217615OtherAETNA (HMO)
G8446ZMedicare UPIN