Organization
ROSLINDALE PEDIATRIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D STACKS M.D. (PRESIDENT)
(617) 522-3100
Entity
Organization
Contact information
Practice address
1153 CENTRE ST, 31, BOSTON, MA 02130-3446
(617) 522-3100
(617) 522-6366
Mailing address
1153 CENTRE ST, 31, BOSTON, MA 02130-3446
(617) 522-3100
(617) 522-6366
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
29672
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036005
NEIGHBORHOOD HLTH PLAN
MA
01
—
600454
TUFTS
MA
01
—
9058
AETNA US HEALTHCARE
MA
05
—
9757864
—
MA
01
—
M14816
BLUE CROSS BLUE SHIELD MA
MA
Enumeration date
01/22/2007
Last updated
08/22/2020
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