Provider Demographics
NPI:1164489514
Name:STOCKMAN, JEFFREY M (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:298 WASHINGTON ST
Mailing Address - Street 2:BABSON PROFESSIONAL BUILDING
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4832
Mailing Address - Country:US
Mailing Address - Phone:978-283-5079
Mailing Address - Fax:978-283-1371
Practice Address - Street 1:298 WASHINGTON ST
Practice Address - Street 2:BABSON PROFESSIONAL BUILDING
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-5079
Practice Address - Fax:978-283-1371
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-12-16
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Provider Licenses
StateLicense IDTaxonomies
MA72203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE68106Medicare UPIN