Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 8541 | MA |
NPI | 1003435116 |
---|---|
Provider Name | Brittany Stamp |
First Address | Tewksbury, MA 01876-2041 |
Second Address | Tewksbury, MA 01876-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |