Healthcare Provider Details

I. General information

NPI: 1932394376
Provider Name (Legal Business Name): STADELMANN CENTER FOR PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST SUITE 201
CONCORD NH
03301-2588
US

IV. Provider business mailing address

248 PLEASANT ST SUITE 201
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 602-224-5200
  • Fax: 603-224-5091
Mailing address:
  • Phone: 602-224-5200
  • Fax: 603-224-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number11822
License Number StateNH

VIII. Authorized Official

Name: DR. WAYNE K. STADELMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 603-224-5200