Provider Demographics
NPI:1518274117
Name:STEFANESCU, ADA (MDCM MSC)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:STEFANESCU
Suffix:
Gender:F
Credentials:MDCM MSC
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:C
Other - Last Name:STEFANESCU SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDCM MSC
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-8052
Mailing Address - Fax:617-726-8000
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-8052
Practice Address - Fax:617-726-8000
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-244803207R00000X
MA254160207R00000X, 207RA0002X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease