MEDICARE: DR. STANLEY P SURETTE

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	207V00000X	Obstetrics & Gynecology Physician	76499	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	:	1447241658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY P SURETTE

Provider Business Mailing Address
First Line	:	328 SHREWSBURY ST
Second Line	:	STE 100
City	:	WORCESTER
State	:	MA
Zip	:	01604-4613
Country	:	US
Telephone Number	:	508-755-4861
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 SHREWSBURY ST
Second Line	:	STE 100
City	:	WORCESTER
State	:	MA
Zip	:	01604-4613
Country	:	US
Telephone Number	:	508-755-4861
Fax Number	:

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	11/30/2016

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Directions to “ DR. STANLEY P SURETTE ” Practice Location

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