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Anesthesiologist (pain control), Pain Management Specialist
27 years of experience
Accepting new patients
Video profile


Education ?

Medical School
University Of Belgrade (1985)
Foreign school

Awards & Distinctions ?

Massachusetts General Hospital
Director, Interventional Pain Program
American Board of Anesthesiology

Affiliations ?

Dr. Stojanovic is affiliated with 5 hospitals.

Hospital Affiliations



  • Massachusetts General Hospital
    55 Fruit St, Boston, MA 02114
    Top 25%
  • Cape Cod Hospital
    PO Box 640, Hyannis, MA 02601
    Top 25%
  • Cape Cod Health Systems
  • Spine & Pain Institute of New England
  • Spaulding Rehabilitation Hospital
    125 Nashua St, Boston, MA 02114
  • Publications & Research

    Dr. Stojanovic has contributed to 20 publications.
    Title Lumbar Zygapophysial (facet) Joint Radiofrequency Denervation Success As a Function of Pain Relief During Diagnostic Medial Branch Blocks: a Multicenter Analysis.
    Date August 2008
    Journal The Spine Journal : Official Journal of the North American Spine Society

    BACKGROUND CONTEXT: The publication of several recent studies showing minimal benefit for radiofrequency (RF) lumbar zygapophysial (l-z) joint denervation have led many investigators to reevaluate selection criteria. One controversial explanation for these findings is that the most commonly used cutoff value for selecting patients for l-z (facet) joint RF denervation, greater than 50% pain relief after diagnostic blocks, is too low and hence responsible for the high failure rate. PURPOSE: To compare l-z joint RF denervation success rates between the conventional greater than or equal to 50% pain relief threshold and the more stringently proposed greater than or equal to 80% cutoff for diagnostic medial branch blocks (MBB). STUDY DESIGN/SETTING: Multicenter, retrospective clinical data analysis. PATIENT SAMPLE: Two hundred and sixty-two patients with chronic low back pain who underwent l-z RF denervation at three pain clinics. OUTCOME MEASURES: Outcome measures were greater than 50% pain relief based on visual analog scale or numerical pain rating score after RF denervation persisting at least 6 months postprocedure, and global perceived effect (GPE), which considered pain relief, satisfaction and functional improvement. METHODS: Data were garnered at three centers on 262 patients who underwent l-z RF denervation after obtaining greater than or equal to 50% pain relief after diagnostic MBB. Subjects were separated into those who received partial (greater than or equal to 50% but less than 80%) and near-complete (greater than or equal to 80%) pain relief from the MBB. Outcomes between groups were compared with multivariate analysis after controlling for 14 demographic and clinical variables. RESULTS: One hundred and forty-five patients obtained greater than or equal to 50% but less than 80% pain relief after diagnostic MBB, and 117 patients obtained greater than or equal to 80% relief. In the greater than or equal to 50% group, success rates were 52% and 67% based on pain relief and GPE, respectively. Among patients who experienced greater than 80% relief from diagnostic blocks, 56% obtained greater than or equal to 50% relief from RF denervation and 66% had a positive GPE. CONCLUSIONS: Using more stringent pain relief criteria when selecting patients for l-z joint RF denervation is unlikely to improve success rates, and may lead to misdiagnosis and withholding a potentially valuable treatment from good candidates.

    Title The Effect of Opioid Dose and Treatment Duration on the Perception of a Painful Standardized Clinical Stimulus.
    Date June 2008
    Journal Regional Anesthesia and Pain Medicine

    BACKGROUND AND OBJECTIVES: The concept of opioid-induced hyperalgesia has recently gained prominence as a contributing factor for opioid tolerance and long-term treatment failure. But whereas the preclinical data for this phenomenon are strong, the mixed clinical data derive primarily from experimental pain models conducted in volunteers and heroin addicts, and nonstandardized clinical stimuli, e.g., surgery. The primary objective of this study is to delineate the effect of opioid dose and treatment duration on pain intensity and unpleasantness ratings following a standardized clinical pain stimulus. METHODS: Three hundred and fifty-five patients, on a steady regimen of analgesic medications and scheduled for an interventional procedure, received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic. Before and immediately following the injection, subjects were asked to rate pain and unpleasantness intensity on a 0 to 10 numerical rating scale. Subjects were stratified into 6 groups based on opioid dosage. A control group of 27 volunteers who had no pain and were taking no analgesics were also injected. RESULTS: Both opioid dose and duration of treatment directly correlated with pain intensity and unpleasantness scores. Baseline pain intensity was also positively associated with both outcome variables. Gender was found to be associated with pain intensity and unpleasantness, with females scoring higher in both categories than males. Compared with patients not receiving opioid treatment, patients receiving opioid therapy were more likely to rate the standardized pain stimulus as being more unpleasant than painful. CONCLUSIONS: The results of this study bolster preclinical and experimental pain models demonstrating enhanced pain perception in subjects receiving opioid therapy. This simple clinical model may provide a useful tool in examining opioid-induced hyperalgesia.

    Title A Differential Diagnosis of Hyperalgesia, Toxicity, and Withdrawal from Intrathecal Morphine Infusion.
    Date December 2007
    Journal Anesthesia and Analgesia

    Opioid-induced hyperalgesia, toxicity, and withdrawal are phenomena that may occur with intrathecal opioid infusion. We present a case in which a patient received intrathecal morphine infusion, and then experienced a clinical course that may have involved hyperalgesia, toxicity, and/or withdrawal. The possible differential diagnosis of opioid-induced hyperalgesia, toxicity, and withdrawal, and its implications in clinical pain management, are discussed. This report demonstrates the complexity of treating patients with long-term continuous intrathecal opioids when modest adjustment of the intrathecal cocktail results in a paradoxical clinical course.

    Title Psychophysical Measurements During Lumbar Discography: a Heart Rate Response Study.
    Date September 2007
    Journal Journal of Spinal Disorders & Techniques

    STUDY DESIGN: Prospective clinical data analysis. OBJECTIVE: To determine if heart rate (HR) response correlates with positive discography results. SUMMARY OF BACKGROUND DATA: Lumbar discography is a controversial tool for the diagnosis of discogenic low back pain. The subjective nature of discography can make data interpretation difficult, leading to false-positive and false-negative results. HR changes have been found in numerous studies to be a reliable and valid indicator of acute pain. To date, there is no study analyzing the HR response to discography-induced pain. METHODS: The HR measurements were recorded immediately preceding and after contrast injection into the each disc, and statistically correlated with the provocation of concordant pain, nonconcordant pain, and nonpainful discs. RESULTS: Discography was performed in 26 subjects with low back pain. Among 75 discograms, 26 discs elicited concordant pain, 9 provoked nonconcordant pain, and 40 elicited no pain response. There was no significant change in HR during disc stimulation for negative [no pain response (P=0.19) and nonconcordant (P=0.26)] discograms, whereas positive discograms [concordant pain (numerical rating scale> or =6/10)] were associated with a statistically significant increase in HR (P=0.000002). CONCLUSIONS: Lumbar discography induces positive HR response only in positive discograms. Although there is no immediate practical application of these results, 2 implications may deserve future research: (a) correlation of HR response with surgical and intradiscal electrotherapy treatment outcomes; (b) evaluation of HR measurement in cases of false-positive results (concordant pain on discography but no HR response).

    Title Clopidogrel Use After Spinal Cord Stimulator Implantation.
    Date June 2007
    Journal Pain Physician
    Title Evaluation of Fluoroscopic Caudal Epidural Steroid Injections.
    Date June 2007
    Journal Pain Physician
    Title Spinal Cord Stimulation.
    Date June 2007
    Journal Pain Physician

    Spinal cord stimulation is the most common mode of neuromodulation used in managing chronic low back pain. It is minimally invasive and reversible as opposed to nerve ablation. The basic scientific background of the initial spinal cord stimulation trials was based on the gate control theory of Melzack and Wall. It has been demonstrated in multiple studies that dorsal horn neuronal activity caused by peripheral noxious stimuli could be inhibited by concomitant stimulation of the dorsal columns. Various other mechanisms, which may play a significant role in the mechanism of action of spinal cord stimulation, include the suppressive effect of spinal cord stimulation on tactile allodynia, increased dorsal horn inhibitory action of gamma-aminobutyric acid (GABA), prevention or abolition of peripheral ischemia, and effects on human brain activity. Spinal cord stimulation is indicated in low back pain with radiculopathy, failed back surgery syndrome, complex regional pain syndrome, peripheral vascular disease, and ischemic heart disease. There is substantial scientific evidence on the efficacy of spinal cord stimulation for treatment of low back and lower extremity pain of neuropathic nature. Clinical studies revealed a success rate of from 50% to 70% with spinal cord stimulation, with decreased pain intensity scores, functional improvement and decreased medication usage. This review discusses multiple aspects of spinal cord stimulation, including pathophysiology and mechanism of action, rationale, indications, technique, clinical effectiveness, and controversial aspects.

    Title Clinical Predictors of Success and Failure for Lumbar Facet Radiofrequency Denervation.
    Date February 2007
    Journal The Clinical Journal of Pain

    OBJECTIVE: To determine the clinical factors associated with the success and failure of radiofrequency denervation of the lumbar facet joints. METHODS: Clinical data were garnered from 3 academic medical centers on 192 patients with low back pain who underwent radiofrequency denervation after a positive response to diagnostic blocks. Success was defined as >/=50% pain relief lasting at least 6 months. Factors evaluated for their association with outcome included duration of pain, opioid use, symptom location, paraspinal tenderness, pain exacerbated by extension/rotation (ie, facet loading), MRI abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery and levels treated. RESULTS: The only factor associated with a successful outcome was paraspinal tenderness. Variables that correlated with treatment failure were 'facet loading,' long duration of pain, and previous back surgery. CONCLUSIONS: It is counterproductive to use 'facet loading' as the sole basis for choosing patients for facet interventions. In patients at high risk for treatment failure, taking additional steps to reduce the rate of false-positive screening blocks may improve outcomes.

    Title Quantitative Sensory Testing for Spinal Cord Stimulation in Patients with Chronic Neuropathic Pain.
    Date January 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain

    OBJECTIVE: A prospective pilot study was conducted, attempting to identify objective tests that would help clinicians to assess the efficacy of spinal cord stimulation (SCS) trial preceding permanent device implantation. Setting: Four university hospitals in the United States and Israel. Participants: Thirteen patients with radicular leg pain due to failed back surgery syndrome (FBSS) or leg pain due to complex regional pain syndrome (CRPS) who were candidates for SCS. METHODS: Participants underwent a series of quantitative sensory tests prior to, and seven days after the initiation of SCS trial. These tests included: vibration threshold (conducted using the VSA 3000; Medoc Inc., Ramat Ishay, Israel), cold threshold, warm threshold, heat pain threshold, phasic heat pain threshold, tonic heat pain threshold (conducted using the TSA 2001; Medoc Inc.), and electrical pain tolerance at 5, 250 and 2000 Hz (administered using the NerveScan 2000; Neurotron, Inc., Baltimore, MD, USA). RESULTS: Useful data were obtained from 12 patients. The results of the vibration threshold and the tolerance to electrical stimulation at 5 and 250 Hz changed with an SCS trial. These results also correlated with the decision regarding the permanent implantation, which was made independently of them. In contrast, the results of thermal thresholds and tolerance to electrical stimulation at 2000 Hz tests did not change with the SCS trial. CONCLUSIONS: Our findings, which agree with those of a few other studies, suggest that the vibration threshold and the tolerance to electrical stimulation at 5 and 250 Hz tests can assist the clinician to select the right patients for permanent stimulation.

    Title A Prospective Crossover Comparison Study of the Single-needle and Multiple-needle Techniques for Facet-joint Medial Branch Block.
    Date February 2006
    Journal Regional Anesthesia and Pain Medicine

    BACKGROUND AND OBJECTIVES: Medial branch blocks have been widely described in the literature as a diagnostic tool for facet joint pain. Recently, a new "single-needle' technique was described that is purported to be equally accurate, and in some respects, superior to the standard multiple-needle technique. To date, no studies have been performed that compared these 2 techniques. METHODS: In a multicenter setting, 24 subjects underwent 2 separate diagnostic medial-branch blocks in a randomized, single-blind crossover comparison of the single-needle and multiple-needle techniques. Multiple variables were compared between the 2 techniques, including procedure-related discomfort, post-procedure pain relief, volume of local anesthetic required, accuracy as determined by final needle position and contrast-media spread, and time needed to perform the procedure. RESULTS: In this pilot study, the single-needle technique resulted in less procedure-related pain (P = .0003), required less superficial local anesthesia (P =.0006), and took less time to complete (P < .0001) than did the multiple-needle approach. With regard to final needle position, contrast spread, and post-procedure pain relief (P = .8), no differences were noted between the 2 techniques. CONCLUSIONS: Our results indicate that the single-needle technique takes less time to perform and causes less patient discomfort than does the standard technique but provides the same degree of accuracy. More studies with larger sample sizes are needed to corroborate these results and explore the effect the single-needle approach has on the rate of false-positive medial branch blocks.

    Title Lumbar Discography: a Comprehensive Review of Outcome Studies, Diagnostic Accuracy, and Principles.
    Date July 2005
    Journal Regional Anesthesia and Pain Medicine

    BACKGROUND AND OBJECTIVES: Since its advent more than 50 years ago, the use of discography has been mired in controversy. The purpose of this review is to provide a clinical overview of lumbar discography and discogenic back pain, with special emphasis on determining the accuracy of discography and whether or not the procedure improves outcomes for surgery. METHODS: Material for this review was obtained from a MEDLINE search conducted from 1951 thru September 2004, bibliographic references, book chapters, and conference proceedings. RESULTS: Based on a large number of comparative studies, plain discography is less accurate than magnetic resonance imaging in diagnosing lumbar herniated nucleus pulposus and comparable or slightly more sensitive in detecting degenerative disc disease. For disc degeneration, CT discography remains the gold standard for diagnosis. There are very few studies comparing surgical outcomes between patients who have undergone preoperative provocative discography and those who have not. What little evidence exists is conflicting. Before disc replacement surgery, approximately half the studies have used preoperative discography. A comparison of outcomes did not reveal any significant difference between the 2 groups but none of the studies was controlled, and they used different outcome measures, follow-up periods, and surgical techniques. Because all intradiscal electrothermal therapy (IDET) studies have used discography before surgery, no conclusions can be drawn regarding its effects on outcome. CONCLUSIONS: Although discography, especially combined with CT scanning, may be more accurate than other radiologic studies in detecting degenerative disc disease, its ability to improve surgical outcomes has yet to be proven. In the United States and Europe, there are inconsistencies in the use of lumbar discography such that it is routinely used before IDET, yet only occasionally used before spinal fusion.

    Title Corticosteroid Injections for Trochanteric Bursitis: is Fluoroscopy Necessary? A Pilot Study.
    Date January 2005
    Journal British Journal of Anaesthesia

    BACKGROUND: Numerous studies have demonstrated that therapeutic injections carried out to treat a variety of different pain conditions should ideally be performed under radiological guidance because of the propensity for blinded injections to be inaccurate. Although trochanteric bursa injections are commonly performed to treat hip pain, they have never been described using fluoroscopy. METHODS: The authors reviewed recorded data on 40 patients who underwent trochanteric bursa injections for hip pain with or without low back pain. The initial needle placement was done blindly, with all subsequent attempts done using fluoroscopic guidance. After bone contact, imaging was used to determine if the needle was positioned on the lateral edge of the greater trochanter (GT). Once this occurred, 1 ml of radiopaque contrast was injected to assess bursa spread. RESULTS: The GT was contacted in 78% of cases and a bursagram obtained in 45% of patients on the first needle placement. In 23% of patients a bursagram was obtained on the second attempt and in another 23% on the third attempt. Four patients (10%) required four or more needle placements before a bursagram was appreciated. Attending physicians obtained a bursagram on the first attempt 53% of the time vs 46% for fellows and 36% for residents (P=0.64). Older patients were more likely to require multiple injections than younger patients. CONCLUSIONS: Radiological confirmation of bursal spread is necessary to ensure that the injectate reaches the area of pathology during trochanteric bursa injections.

    Title The Causes of False-positive Medial Branch (facet Joint) Blocks in Soldiers and Retirees.
    Date December 2004
    Journal Military Medicine

    OBJECTIVE: The purpose of this study was to determine the factors associated with false-positive medial branch blocks (MBB), the nerve blocks used to diagnose facet arthropathy, in soldiers and retirees. METHODS: The study subjects were 78 patients with chronic low back pain who underwent diagnostic MBB to determine whether or not the facet joints were pain generators. Radiofrequency denervation of these nerves was performed in all patients with positive responses. Patients who failed to obtain pain relief after the blocks (negative blocks) and those who obtained temporary pain relief after MBB but failed radiofrequency denervation (false-positive blocks) then proceeded to undergo discography. Based on patients' responses to diagnostic blocks, discography results, the presence of radicular pain, and previous back surgery, the data were analyzed to determine whether any of these variables correlated with false-positive MBB. RESULTS: The presence of discogenic or radicular pain was not associated with a higher false-positive response rate to MBB. Conversely, the absence of discogenic pain was associated with a higher percentage of false-positive blocks. There was also a trend for patients with previous back surgery to have a higher false-positive rate than those who had not undergone previous surgery. CONCLUSIONS: Although a high incidence of epidural and foraminal spread occurs during the performance of MBB, this is unlikely to be a significant cause of false-positive blocks.

    Title The Predictive Value of Sympathetic Block for the Success of Spinal Cord Stimulation.
    Date October 2003
    Journal Neurosurgery

    OBJECTIVE: The purpose of this study was to assess the predictive value of response to sympathetic blockade (SB) on the success rate of spinal cord stimulation (SCS) in patients with complex regional pain syndrome. METHODS: We performed a retrospective study on 23 patients with complex regional pain syndrome who underwent both SB and subsequent SCS trials in the past 3 years at the Massachusetts General Hospital Pain Center, Boston, MA, and Walter Reed Army Medical Center, Washington, DC. Fifteen of these patients underwent permanent placement of an SCS device, and pain relief at 1- and 9-month follow-up was recorded. RESULTS: Among the 23 patients included in the study, those having transient pain relief with SB were more likely to have a positive SCS trial: all 13 with positive SB had good pain relief during the trial, compared with only 3 of the 10 with negative SB (100% versus 30%, P < 0.001). Among the 10 patients with negative SB, 7 noted poor pain relief during the trial despite adequate coverage, and they did not undergo placement of a permanent device. Among the patients who underwent permanent placement of an SCS device, those who received good pain relief with SB were more likely to have greater than 50% pain relief at 1-month follow-up (100% versus 33%, P = 0.029) and 9-month follow-up (87.5% versus 33.3%, P = 0.15). CONCLUSION: We conclude that patients with good response to SB before SCS are more likely to have a positive response during their SCS trial and long-term pain relief after placement of permanent SCS device.

    Title Multiple Bier Blocks with Labetalol for Complex Regional Pain Syndrome Refractory to Other Treatments.
    Date May 2003
    Journal Journal of Pain and Symptom Management
    Title Single Needle Approach for Multiple Medial Branch Blocks: a New Technique.
    Date April 2003
    Journal The Clinical Journal of Pain

    BACKGROUND AND OBJECTIVES: Medial branch blocks are an important tool for the diagnosis of facet joint arthropathy. The most commonly used technique involves multiple needle placements, one for each nerve blocked. This multiple needle technique may require a large amount of local anesthetic for anesthetizing the skin, thereby increasing the rate of false-positive blocks. TECHNIQUE: Diagnostic lumbar medial branch blocks are usually performed using multiple needles, one for each branch. The authors describe a different technique using a single needle for all levels. Initially, the needle is directed toward the medial branch located at the level of the affected facet joint in the antero-posterior view. After anesthetizing this nerve with local anesthetic, the same needle is withdrawn to the skin with the tip still in the subcutaneous tissue and repositioned to block the medial branch above, and thereafter below, while continuing to use only the antero-posterior view, thereby using only one entry site. CONCLUSIONS: When performed correctly, the single needle technique provides accuracy similar to the more conventional multiple needle approach during the performance of diagnostic facet joint nerve blocks. Because only one skin entry point is needed, however, this technique may afford several advantages over the multiple needle approach. These may include less patient discomfort, less time required and less radiation exposure since only one C-arm position is used, a smaller volume of local anesthetic, and possibly a lower incidence of false-positive blocks.

    Title The Technical Aspects of Epidural Steroid Injections: a National Survey.
    Date August 2002
    Journal Anesthesia and Analgesia

    Although epidural steroid injections (ESIs) are a common treatment for chronic pain conditions, it is not clear whether there is consensus on their technical aspects. The current literature suggests that variations in technical aspects may affect ESI outcomes. The goal of the survey was to help establish a standard frame of reference for the performance of ESIs. We analyzed survey results from 68 academic anesthesia programs and 28 private practices in the United States. The main finding in this survey is that there is no clear-cut consensus as to the ideal method to perform ESI. There is a wide variation among individual practices in almost every technical aspect of ESI. Private practices use significantly more fluoroscopy than academic centers. The large difference was found in the cervical region where 73% of private practices and only 39% of academic institutions polled perform the ESIs with fluoroscopic guidance (P = 0.005). A similar discrepancy was found in approaches to the epidural space after laminectomy where 61% of private practices, but only 15% of academic centers, use the transforaminal approach. The study results indicate that there is no consensus, and that there is a wide variation in current practices. IMPLICATIONS: A national survey of practices performing epidural steroid injections was conducted. The purpose was to establish whether consensus exists on technical aspects of this procedure. The study results indicate that there is no consensus, and that there is a wide variation in current practices.

    Title The Role of Fluoroscopy in Cervical Epidural Steroid Injections: an Analysis of Contrast Dispersal Patterns.
    Date May 2002
    Journal Spine

    STUDY DESIGN: A multicenter, retrospective analysis of cervical epidurograms. OBJECTIVES: To determine the effectiveness of the loss of resistance (LOR) technique in identifying the cervical epidural space. To delineate the pattern of epidural contrast spread during cervical epidural steroid injections. BACKGROUND: Previous studies have shown that if performed without fluoroscopy, the LOR technique can result in inaccurate needle placement in up to 30% of lumbar epidural steroid injections. To date, no study has examined accuracy of LOR technique and pattern of radiographic contrast spread in cervical epidural levels. METHODS: Epidurograms of 38 cervical epidural steroid injections in 31 patients were reviewed. The number of LOR attempts and pattern of contrast spread was analyzed. The effects of age, gender, MRI results, previous cervical laminectomy, and the physician's level of training were correlated with results. RESULTS: The authors found a 53% rate of false LOR during the first attempt to enter the epidural space. Unilateral epidural contrast spread was found in 51% and ventral epidural spread was found in 28% of cases. The average number of cervical vertebral levels covered with 2 mL of contrast was 3.14, with significantly wider spread noted in those patients who had not undergone previous cervical laminectomy. Other variables did not influence the accuracy of needle placement and pattern of epidural contrast spread. CONCLUSIONS: The loss of resistance technique may not be an adequate method for ensuring accurate needle placement in blindly performed cervical epidural injections. The use of epidurography can improve the accuracy of needle placement and medication delivery to targeted areas of pathology.

    Title Stimulation Methods for Neuropathic Pain Control.
    Date June 2001
    Journal Current Pain and Headache Reports

    Neurostimulation methods for control of chronic neuropathic pain have recently gained in popularity. The reasons for this are multifactorial. As opposed to nerve ablation, these methods are minimally invasive and reversible. The improvements in hardware design simplified implantation techniques and prolonged equipment longevity. Stimulation trials have become less invasive, allowing patients to test its effects before final implantation. Finally, the scientific evidence has shown good outcomes of neurostimulation methods for chronic neuropathic pain control. Recent research efforts have revealed new potential mechanisms of action of neurostimulation. Whereas its action was widely explained by gate control theory in the past, it seems that neuromodulation acts also by modulation of neurotransmitters in the central nervous system. Three neurostimulation methods are currently used in clinical practice: spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), and deep brain stimulation (DBS). The SCS and PNS are excellent treatment choices for certain forms of neuropathic pain. The new indications for SCS are end-stage peripheral vascular disease and ischemic heart disease, whereas PNS is used for the treatment of occipital neuralgia and chronic pelvic pain. DBS is reserved for carefully selected patients in whom the other treatment modalities have failed. In a minority of patients the "tolerance" to neurostimulation develops after long-term use. Further research is needed to establish better outcome predictors to neurostimulation and possibly improve patient selection criteria.

    Title Intravenous Lidocaine for Treatment-resistant Pruritus.
    Date July 1997
    Journal The American Journal of Medicine

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