Provider Demographics
NPI:1366436644
Name:STUBBERT, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:STUBBERT
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 1:67 GRAND ARMY HWY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1220
Mailing Address - Country:US
Mailing Address - Phone:508-678-5633
Mailing Address - Fax:508-673-5605
Practice Address - Street 1:67 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1220
Practice Address - Country:US
Practice Address - Phone:508-678-5633
Practice Address - Fax:508-673-5605
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A59632Medicare UPIN
K08317Medicare PIN