Provider Demographics
NPI:1003900192
Name:BAE, STELLA J (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:J
Last Name:BAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FAYERWEATHER ST
Mailing Address - Street 2:APT.# 3
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1202
Mailing Address - Country:US
Mailing Address - Phone:617-566-1055
Mailing Address - Fax:
Practice Address - Street 1:49 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3188
Practice Address - Country:US
Practice Address - Phone:617-566-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1536562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry