Provider Demographics
NPI:1639708886
Name:STANEK, AGATHA (MD)
Entity Type:Individual
Prefix:MISS
First Name:AGATHA
Middle Name:
Last Name:STANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 FRANCIS STREET
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:438-838-0938
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:438-838-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10166282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology