Provider Demographics
NPI:1992850440
Name:STAGER, CHRISTOPHER D (PA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:D
Last Name:STAGER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:RM 339
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5359
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:11 NEVINS ST.
Practice Address - Street 2:STE 306
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2045
Practice Address - Fax:617-789-2932
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ03693Medicare UPIN