Provider Demographics
NPI:1275817926
Name:STETSON, GARRETT W (MA)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:W
Last Name:STETSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-5428
Mailing Address - Country:US
Mailing Address - Phone:508-849-5640
Mailing Address - Fax:
Practice Address - Street 1:2 GRANITE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-5428
Practice Address - Country:US
Practice Address - Phone:508-849-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program