Provider Demographics
NPI:1003106436
Name:MARONEY, STEPHANIE JACQUELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JACQUELYN
Last Name:MARONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HUMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:GREEN MOB, SUITE 563
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-219-1285
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON STREET
Practice Address - Street 2:GREEN MOB, SUITE 563
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-219-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122712208600000X
MA2817222086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care