Healthcare Provider Details

I. General information

NPI: 1992913982
Provider Name (Legal Business Name): JOHN G STAGIAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 HAMILTON ST
SOUTHBRIDGE MA
01550-1859
US

IV. Provider business mailing address

428 HAMILTON ST
SOUTHBRIDGE MA
01550-1859
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-1600
  • Fax: 508-764-2502
Mailing address:
  • Phone: 508-765-1600
  • Fax: 508-764-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number80381
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN GUS STAGIAS
Title or Position: DR JOHN G STAGIAS
Credential: MD
Phone: 508-765-1600