Provider Demographics
NPI:1538294632
Name:STASKO SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:STASKO SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STASKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-724-8877
Mailing Address - Street 1:924 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1851
Mailing Address - Country:US
Mailing Address - Phone:301-724-8877
Mailing Address - Fax:301-724-2683
Practice Address - Street 1:924 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1851
Practice Address - Country:US
Practice Address - Phone:301-724-8877
Practice Address - Fax:301-724-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD619LMedicare ID - Type Unspecified