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NPI Code Detail

MEDICARE: AMELIA GRACE STAPLETON VAN DOREN MD

MEDICARE: AMELIA GRACE STAPLETON VAN DOREN 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356286660
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMELIA GRACE STAPLETON VAN DOREN MD
Provider Business Mailing Address
First Line : 72 HAMILTON ST APT 4
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-4567
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 736 CAMBRIDGE ST
Second Line :
City : BRIGHTON
State : MA
Zip : 02135-2907
Country : US
Telephone Number : 617-789-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2026
Last Update Date : 05/25/2026

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