MEDICARE: INGO H STUBBE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	79710	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164476503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGO H STUBBE MD

Provider Business Mailing Address
First Line	:	45 HUNNEWELL ST
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-5411
Country	:	US
Telephone Number	:	781-237-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 HIGHLAND AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1408
Country	:	US
Telephone Number	:	617-591-4920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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Directions to “ INGO H STUBBE MD” Practice Location

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