Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 3445 | NH |
Y | 213EG0000X | General Practice | 3445 | NH |
NPI | 1003836206 |
---|---|
Provider Name | Dr. Ronald Stanko |
First Address | Plymouth, NH 03264 |
Second Address | Plymouth, NH 03264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30303285 | (05) | NH |