Provider Demographics
NPI:1356323646
Name:STAFFA, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:STAFFA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-853-2716
Mailing Address - Fax:508-854-0479
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-853-2716
Practice Address - Fax:508-854-0479
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA704122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA732821OtherTUFTS HEALTH PLAN
MAJ10760OtherBCBS MA
MA3076351Medicaid
MA3076351Medicaid
MAJ10760OtherBCBS MA