Provider Demographics
NPI:1225522535
Name:STOJANOVIC, IRINA IVA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:IVA
Last Name:STOJANOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 HEALD RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1418
Mailing Address - Country:US
Mailing Address - Phone:978-369-4248
Mailing Address - Fax:
Practice Address - Street 1:75 GREAT RD STE 201
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5678
Practice Address - Country:US
Practice Address - Phone:978-277-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist