Provider Demographics
NPI:1639116007
Name:STASNY, ELAINE V (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:V
Last Name:STASNY
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 1:97 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9280
Mailing Address - Country:US
Mailing Address - Phone:802-748-5131
Mailing Address - Fax:
Practice Address - Street 1:97 SHERMAN DR
Practice Address - Street 2:ST JOHNSBURY PEDIATRICS
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9280
Practice Address - Country:US
Practice Address - Phone:802-748-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-000778208000000X
NH10695208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200431Medicaid
VT0VN2061Medicaid
VTVN2061Medicare ID - Type Unspecified
NH30200431Medicaid