Provider Demographics
NPI:1932394376
Name:STADELMANN CENTER FOR PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:STADELMANN CENTER FOR PLASTIC SURGERY, P.C.
Other - Org Name:WAYNE K. STADELMANN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STADELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-224-5200
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:602-224-5200
Mailing Address - Fax:603-224-5091
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:602-224-5200
Practice Address - Fax:603-224-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH118222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7067OtherMEDICARE INDIVIDUAL PROV#
NHRE7068OtherMEDICARE GROUP PROV#