Healthcare Provider Details

I. General information

NPI: 1326213372
Provider Name (Legal Business Name): BRYAN PAYNE STANIFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF SURGERY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

161 FORT WASHINGTON AVENUE 3RD FLOOR
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8022
  • Fax:
Mailing address:
  • Phone: 212-305-4646
  • Fax: 212-305-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number288690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: