1154391837 NPI number — MILANA STAVITSKY MD

Table of content: MILANA STAVITSKY MD (NPI 1154391837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154391837 NPI number — MILANA STAVITSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAVITSKY
Provider First Name:
MILANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154391837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 WORCESTER ST
Provider Second Line Business Mailing Address:
SUITE 103-105
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-235-9737
Provider Business Mailing Address Fax Number:
781-235-9738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 WORCESTER ST
Provider Second Line Business Practice Location Address:
SUITE 103-105
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-235-9737
Provider Business Practice Location Address Fax Number:
781-235-9738
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  78887 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M19207 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-1792042 . This is a "TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: C31654 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200995 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3149811 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402449 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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