Provider Demographics
NPI:1194711614
Name:ADELSTEIN, STANLEY JAMES (MD, PHD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:JAMES
Last Name:ADELSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:JAMES
Other - Last Name:ADELSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:220 LONGWOOD AVE
Mailing Address - Street 2:GOLDENSON BUILDING--ROOM B244
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5701
Mailing Address - Country:US
Mailing Address - Phone:617-432-4152
Mailing Address - Fax:617-432-2419
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23929207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07554OtherBLUE CROSS/BLUE SHIELD
MA02329OtherTUFTS HEALTH CARE
MAB75585BWHTOtherHARVARD PILGRIM HEALTH CA
MA2036142Medicaid
MA2036142Medicaid
MA02329OtherTUFTS HEALTH CARE