Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 281722 | MA |
Y | 208600000X | Surgeon | 281722 | MA |
N | 208200000X | Surgeon | A122712 | CA |
N | 208600000X | Surgeon | A122712 | CA |
N | 2086S0102X | Surgical Critical Care | 281722 | MA |
NPI | 1003106436 |
---|---|
Provider Name | Dr. Stephanie Jacquelyn Maroney |
First Address | Newton, MA 02462 |
Second Address | Newton, MA 02462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 01/12/2021 |