Individual
STEPHANIE L BLENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 442-3028
(774) 442-6740
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
216795
MA
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
216795
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110034009A
—
MA
Enumeration date
01/10/2006
Last updated
04/18/2017
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