Provider Demographics
NPI:1659364925
Name:SMITH, STACY E (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:RADIOLOGY BRIGHAM AND WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-7537
Mailing Address - Fax:617-525-7333
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-7537
Practice Address - Fax:617-525-7333
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00541372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC38110031OtherCAREFIRST BCBS
MD967707OtherAETNA HMO
MD5235541OtherAETNA PPO
MDKC46SH69762202OtherCAREFIRST BCBS
MD110800000Medicaid
MD865L201EMedicare PIN
DC38110031OtherCAREFIRST BCBS
MA001232201Medicare PIN
MD110800000Medicaid
MD545L E459Medicare PIN