Basic Information
Provider Information
NPI: 1245232776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STOENESCU
FirstName: MATHIAS
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 2500 NE NEFF RD
Address2:  
City: BEND
State: OR
PostalCode: 977016015
CountryCode: US
TelephoneNumber: 5413884333
FaxNumber: 5413883446
Other Information
ProviderEnumerationDate: 08/15/2005
LastUpdateDate: 04/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0001X234714MAY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

No ID Information.


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