Provider Demographics
NPI:1669445243
Name:STANWOOD, WALTER G (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:G
Last Name:STANWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-2350
Mailing Address - Fax:781-934-5640
Practice Address - Street 1:41 RESNIK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4842
Practice Address - Country:US
Practice Address - Phone:781-934-2400
Practice Address - Fax:508-746-3930
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218962204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00053230OtherRAILROAD MEDICARE
MA2017202Medicaid
MA2017202Medicaid
MA218962OtherTUFTS
MAJ26506OtherBLUE CROSS BLUE SHIELD
MA218962OtherUNICARE
MA9528291001OtherCIGNA HEALTHCARE
MA2017202Medicaid
MAH91587Medicare UPIN