Provider Demographics
NPI:1801848593
Name:STAMATO, NICHOLAS J (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:STAMATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3011
Mailing Address - Country:US
Mailing Address - Phone:307-688-3700
Mailing Address - Fax:307-685-3079
Practice Address - Street 1:501 S BURMA AVE STE 3500
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-688-3700
Practice Address - Fax:307-688-7920
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY9526A207RC0000X, 207RI0011X
NY158778207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01346327Medicaid
NY01346327Medicaid
34864BMedicare ID - Type Unspecified