Healthcare Provider Details

I. General information

NPI: 1548238405
Provider Name (Legal Business Name): BRUCE A STELLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TROWBRIDGE ROAD SUITE 100
BOURNE MA
02532
US

IV. Provider business mailing address

25 COMMUNICATIONS WAY MACC - REVENUE CYCLE
HYANNIS MA
02601-1866
US

V. Phone/Fax

Practice location:
  • Phone: 508-743-0314
  • Fax: 508-759-2478
Mailing address:
  • Phone: 508-957-8664
  • Fax: 508-957-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number052714
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: