Provider Demographics
NPI:1861441891
Name:STAMOULIS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STAMOULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1242
Mailing Address - Country:US
Mailing Address - Phone:508-996-3991
Mailing Address - Fax:
Practice Address - Street 1:535 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1242
Practice Address - Country:US
Practice Address - Phone:508-996-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2195742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11059962AMedicaid
MAS400142217Medicare UPIN
MA3428914OtherAETNA
MA000000027040OtherBMC HEALTHNET
MA0500924OtherUNITED HEALTHCARE
MA411474OtherBLUE CHIP RI
MA5838938OtherCIGNA
MAAA4401OtherHARVARD PILGRIM
MA468638OtherTUFTS/SECURE HORIZONS
MAJ26885OtherBC/BS
MAA36176Medicare ID - Type Unspecified
MA04-3568655OtherHEALTHCARE VALUE MANAGEME
MA3428914OtherUS HEALTHCARE
MAG27495Medicare UPIN