Provider Demographics
NPI:1063499051
Name:STANLEY, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1937
Mailing Address - Country:US
Mailing Address - Phone:781-826-8065
Mailing Address - Fax:781-826-8043
Practice Address - Street 1:28 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1937
Practice Address - Country:US
Practice Address - Phone:781-826-8065
Practice Address - Fax:781-826-8043
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA70472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070472OtherTUFTS HEALTH PLAN
MA70257OtherHARVARD PILGRIM
MA3116751Medicaid
MAJ30154OtherBLUE CROSS BLUE SHIELD
MA3116751Medicaid
MA70257OtherHARVARD PILGRIM