Provider Demographics
NPI:1568981249
Name:STELLA, VINCENT JAMES III (PA-C)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES
Last Name:STELLA
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ORCHARD AVE # 0
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2219
Mailing Address - Country:US
Mailing Address - Phone:203-260-6628
Mailing Address - Fax:
Practice Address - Street 1:125 PARKER HILL AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2865
Practice Address - Country:US
Practice Address - Phone:617-754-5754
Practice Address - Fax:617-754-6490
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA6354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant