Provider Demographics
NPI:1407169717
Name:STULAC, SARA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:STULAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 COMMONWEALTH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1205
Mailing Address - Country:US
Mailing Address - Phone:617-998-8922
Mailing Address - Fax:617-432-5300
Practice Address - Street 1:850 HARRISON AVENUE
Practice Address - Street 2:YAWKEY 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12857208000000X
MA248883208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119302AMedicaid