Provider Demographics
NPI:1275654089
Name:STANTON MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:STANTON MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-782-5700
Mailing Address - Street 1:280 WASHINGTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-782-5700
Mailing Address - Fax:617-782-2250
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-782-5700
Practice Address - Fax:617-782-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM10847Medicare ID - Type Unspecified