Provider Demographics
NPI:1215923388
Name:SCHNELLER, STUART JOEL (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:JOEL
Last Name:SCHNELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE STREET
Mailing Address - Street 2:BONE & JOINT CENTER, CCP-9
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-787-5111
Mailing Address - Fax:617-787-5150
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CCP-9
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-787-5111
Practice Address - Fax:617-787-5150
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41617207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103527Medicaid
MAD82821Medicare UPIN
MAE05200Medicare ID - Type Unspecified