Healthcare Provider Details

I. General information

NPI: 1992794515
Provider Name (Legal Business Name): ANA STANKOVIC MD FACP FASN FASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STILES RD STE 2400
SALEM NH
03079
US

IV. Provider business mailing address

31 STILES RD STE 2400
SALEM NH
03079-3037
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-2771
  • Fax: 603-890-2886
Mailing address:
  • Phone: 603-890-2771
  • Fax: 603-890-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number13080
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: