Healthcare Provider Details

I. General information

NPI: 1982967444
Provider Name (Legal Business Name): STEPHEN JAMES FIASCONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE # YACC5
BOSTON MA
02118-4001
US

IV. Provider business mailing address

720 HARRISON AVE # DOB503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-2000
  • Fax: 617-414-5798
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number265730
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: