Provider Demographics
NPI:1821087289
Name:BREEN GREALLY, STACEY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:BREEN GREALLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:93 POND ST
Mailing Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2015
Mailing Address - Country:US
Mailing Address - Phone:781-784-9212
Mailing Address - Fax:781-784-7671
Practice Address - Street 1:93 POND ST
Practice Address - Street 2:BETH ISRAEL DEACONESS HEALTH CARE- SHARON
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2015
Practice Address - Country:US
Practice Address - Phone:781-784-9212
Practice Address - Fax:781-784-7671
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2016-08-10
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Provider Licenses
StateLicense IDTaxonomies
MA216484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2076501Medicaid
MAA37335Medicare ID - Type Unspecified
MA2076501Medicaid