Healthcare Provider Details

I. General information

NPI: 1184241937
Provider Name (Legal Business Name): GEORGE STALCUP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

5 WATER ST
SHREWSBURY MA
01545-4228
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7000
  • Fax:
Mailing address:
  • Phone: 919-717-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberETLL-757
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: