Individual
DR. KEVIN JOSEPH STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 FRUIT STREET, WAC 708D, BOSTON, MA 02114
(617) 643-0363
(617) 643-0141
Mailing address
3 SHIPWAY PL, CHARLESTOWN, MA 02129-4301
(617) 643-0363
(617) 643-0141
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
230011
MA
Other
Enumeration date
06/04/2006
Last updated
12/26/2012
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