MEDICARE: DR. MARY E STAUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	35048595	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568439024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E STAUS MD

Provider Business Mailing Address
First Line	:	6046 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7616
Country	:	US
Telephone Number	:	330-433-1353
Fax Number	:	330-433-1560

Provider Business Practice Location Address
First Line	:	6046 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7616
Country	:	US
Telephone Number	:	330-433-1353
Fax Number	:	330-433-1560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	02/17/2012

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Directions to “ DR. MARY E STAUS MD” Practice Location

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