Provider Demographics
NPI:1255378899
Name:STEIN, CYNTHIA J (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:STEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5728
Mailing Address - Country:US
Mailing Address - Phone:617-355-3501
Mailing Address - Fax:617-731-5298
Practice Address - Street 1:319 LONGWOOD AVE
Practice Address - Street 2:SPORTS MEDICINE 6TH FLR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5728
Practice Address - Country:US
Practice Address - Phone:617-355-3501
Practice Address - Fax:617-731-5298
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208003207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104920Medicaid
I49165Medicare UPIN
MAOX1210Medicare PIN
MAA39600Medicare PIN