Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 52773 | MA |
N | 208000000X | Pediatrician | 52773 | MA |
NPI | 1740270107 |
---|---|
Provider Name | Dr. Joan Marilyn Stoler |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 16/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052773 | TUFTS HEALTH PLAN (01) | MA |
6198511 | (05) | MA |
D88405 | (02) | |
J04982 | BCBS MA (01) | MA |