Provider Demographics
NPI:1356380448
Name:HOM, STANLEY (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:HOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:G3
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-9299
Mailing Address - Fax:617-298-2107
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:G3
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-9299
Practice Address - Fax:617-298-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58824207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3036260Medicaid
MA17352OtherHARVARD PILGRIM
MA709171OtherTUFTS
MAJ06916OtherBLUE SHIELD
MAB98100Medicare UPIN