Provider Demographics
NPI:1790866739
Name:STAGNO, PAUL ANTHONY (MD, PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:STAGNO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 LORAIN AVE
Mailing Address - Street 2:DEPT. OF PATHOLOGY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-7108
Mailing Address - Fax:216-476-7109
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7108
Practice Address - Fax:216-476-7109
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052030207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000024197OtherANTHEM BC/BS
OH0752378OtherBCMH
OH1100290OtherUNITED HEALTH CARE
OH340714618011OtherMEDICAL MUTUAL OHIO
OH1316OtherUNITED MINE WORKERS
OH340714618144OtherCARESOURCE
OH5954238OtherAETHNA US HEALTHCARE
OH000000024197OtherUNICARE
OH000000024197OtherOHIO OPER. ENGINEERS
OHST7134671Medicare ID - Type UnspecifiedMEDICARE OHIO/WEST VIRG.
OH340714618144OtherCARESOURCE
OH1100290OtherUNITED HEALTH CARE