Provider Demographics
NPI:1871689828
Name:STACEY, SARA J (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:STACEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WHITEHALL ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3425
Mailing Address - Country:US
Mailing Address - Phone:603-330-7905
Mailing Address - Fax:603-330-7906
Practice Address - Street 1:11 WHITEHALL ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3226
Practice Address - Country:US
Practice Address - Phone:603-330-7905
Practice Address - Fax:603-330-7906
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH10064207Q00000X
NH10064208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHF46524Medicare UPIN
NHSTRE4723Medicare ID - Type Unspecified