Provider Demographics
NPI:1831304211
Name:STODDARD, PHILIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:B
Last Name:STODDARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:234 BONNETT RD
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036
Mailing Address - Country:US
Mailing Address - Phone:413-566-3742
Mailing Address - Fax:
Practice Address - Street 1:516 CAREW ST
Practice Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-787-2079
Practice Address - Fax:413-787-2012
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA33289208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery