Healthcare Provider Details

I. General information

NPI: 1235324047
Provider Name (Legal Business Name): THOR D. STEIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
BOSTON MA
02132-4927
US

IV. Provider business mailing address

258 HARVARD ST # 104
BROOKLINE MA
02446-2904
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number246544
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: