Provider Demographics
NPI:1932107216
Name:STADELMANN, WAYNE K (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:K
Last Name:STADELMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-5200
Mailing Address - Fax:603-224-5091
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-224-5200
Practice Address - Fax:603-224-5091
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRE70682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1932107216Medicaid
NH1932107216Medicaid
NHRE7068Medicare ID - Type Unspecified