Healthcare Provider Details

I. General information

NPI: 1154749703
Provider Name (Legal Business Name): STEPHANIE DIANE TALUTIS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVENUE, 3RD FLOOR WEST PRESTON BLDG.
BOSTON MA
02118-2309
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8488
  • Fax: 617-638-8469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number268764
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number268764
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: