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General NPI Number Information
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NPI Number | 1922082932
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Entity Type | Individual
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Provider Name | STEVEN MARSHALL STUFFLEBEAM MD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 55 FRUIT STREET FND2 RADIOLOGICAL ASSOCIATES
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City | BOSTON
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State | MA
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Zip | 02114-2696
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Country | US
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Telephone | 617-726-0963
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Fax | 617-726-7422
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Provider Business Mailing Address
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Address Line | PO 9142 MASS GENERAL PHYSICIAN ORGANIZATION
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City | CHARLESTOWN
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State | MA
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Zip | 02129-9142
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Country | US
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Telephone | 617-726-0963
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Fax | 617-726-7422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 212768
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License Number State | MA
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