Healthcare Provider Details

I. General information

NPI: 1922598762
Provider Name (Legal Business Name): MICHAEL STANLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 09/30/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TUFTS MEDICAL CENTER 800 WASHINGTON STREET
BOSTON MA
02116
US

IV. Provider business mailing address

TUFTS MEDICAL CENTER, NEUROLOGY DEPT 260 TREMONT STREET OFFICE #1242, 12TH FLOOR, BIEWEND BUILDING
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number291572
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: