Individual
SUSAN STAGNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106
(216) 844-2400
Mailing address
20800 HARVARD ROAD, 2ND FLOOR, HIGHLAND HILLS, OH 44122
(216) 286-6260
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35048038S
OH
2084P0015X
Psychosomatic Medicine Physician
35-048038
OH
2084P0800X
Psychiatry Physician
35-04-8038
OH
2084P0800X
Psychiatry Physician
Primary
35048038S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365167
ANTHEM
OH
05
—
0594192
—
OH
01
—
P00469476
MEDICARE RAILROAD
—
Enumeration date
07/27/2006
Last updated
01/11/2021
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