Provider Demographics
NPI:1174509269
Name:STANLEY, GLYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLYNNE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:690 CANTON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2321
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:690 CANTON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2321
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA150109207L00000X
MEME23448207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1174509269Medicaid
MA3147452Medicaid
MAA20887Medicare PIN
G19334Medicare UPIN