Healthcare Provider Details

I. General information

NPI: 1902995996
Provider Name (Legal Business Name): STEPHEN ALBERT HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE CHILDREN'S HOSPITAL BOSTON - DIVISION OF ENDOCRINOLOGY
BOSTON MA
02115
US

IV. Provider business mailing address

185 MASSACHUSETTS AVE APT. 504
BOSTON MA
02115-3030
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-2452
  • Fax: 617-730-0194
Mailing address:
  • Phone: 617-355-2452
  • Fax: 617-731-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number160897
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: