Individual
DR. ANNE M STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6624
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
74040
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
74040
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3089890
—
MA
Enumeration date
05/03/2006
Last updated
08/14/2007
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