Provider Demographics
NPI:1598712739
Name:STUPNYTSKYI, OLEKSANDR (MD)
Entity Type:Individual
Prefix:
First Name:OLEKSANDR
Middle Name:
Last Name:STUPNYTSKYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:APT 203
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2357
Mailing Address - Country:US
Mailing Address - Phone:978-725-5913
Mailing Address - Fax:978-725-5918
Practice Address - Street 1:25 MARSTON STREET
Practice Address - Street 2:404A
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:978-725-5913
Practice Address - Fax:978-725-5918
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36415208M00000X
MA233485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
95867101OtherNETWORK HEALTH
7778264OtherAETNA
1598712739OtherBMC
MA2140233Medicaid
510492088OtherUHC
29164OtherFALLON
AA98601OtherHPHC
J42413OtherBCBS
496927OtherTUFTS
MA000414901Medicare PIN
29164OtherFALLON
MA2140233Medicaid