Provider Demographics
NPI:1588821219
Name:STOCK, CAMERON T (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:T
Last Name:STOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-2657
Practice Address - Country:US
Practice Address - Phone:781-744-8022
Practice Address - Fax:781-744-5359
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA261704208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110101878AMedicaid
MAS400197622Medicare PIN