Provider Demographics
NPI:1427255140
Name:STIPPLER, MARTINA (MD)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:STIPPLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRANCIS ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-9943
Mailing Address - Fax:617-632-0949
Practice Address - Street 1:110 FRANCIS ST STE 3B
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-9943
Practice Address - Fax:617-632-0949
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426995207T00000X
NMMD2009-0123207T00000X
MA257194207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery