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NPI Code Detail

MEDICARE: DR. MARY M STAFFA MD

MEDICARE: DR. MARY M STAFFA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician70412MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1732821OTHERMATUFTS HEALTH PLAN
2J10760OTHERMABCBS MA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356323646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY M STAFFA MD
Provider Business Mailing Address
First Line : 5 NEPONSET ST FL STREET12
Second Line :
City : WORCESTER
State : MA
Zip : 01606-2714
Country : US
Telephone Number : 508-853-2716
Fax Number : 508-854-0479
Provider Business Practice Location Address
First Line : 5 NEPONSET ST
Second Line :
City : WORCESTER
State : MA
Zip : 01606-2714
Country : US
Telephone Number : 508-853-2716
Fax Number : 508-854-0479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 09/14/2018

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