Provider Demographics
NPI:1740245505
Name:MACAUSLAND, STEPHANIE G (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:MACAUSLAND
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 1:20 PROSPECT ST
Mailing Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3026
Mailing Address - Country:US
Mailing Address - Phone:508-488-3800
Mailing Address - Fax:508-488-3800
Practice Address - Street 1:20 PROSPECT ST
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3026
Practice Address - Country:US
Practice Address - Phone:508-488-3800
Practice Address - Fax:508-488-3800
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD118432085R0001X
MA2129022085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057906Medicaid
RI3600729OtherUNITED HEALTHCARE
RI4804-8OtherBLUE CROSS BLUE SHIELD
RIAA38707OtherHARVARD PILGRIM
RI4804-8OtherBLUE CROSS BLUE SHIELD
RI7057906Medicaid