Provider Demographics
NPI:1396871984
Name:HOCHBERG, STANLEY M (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:HOCHBERG
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 1:14 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3019
Mailing Address - Country:US
Mailing Address - Phone:617-374-8505
Mailing Address - Fax:
Practice Address - Street 1:MED VENTIVE
Practice Address - Street 2:1 KENDALL SQ BLDG 200
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-374-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine