1801864202 NPI number — MS. KIMBERLY STEGMAIER MD

Table of content: MS. KIMBERLY STEGMAIER MD (NPI 1801864202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801864202 NPI number — MS. KIMBERLY STEGMAIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEGMAIER
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801864202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 PRINCE STREET
Provider Second Line Business Mailing Address:
#1
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-983-3943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BINNEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-4985
Provider Business Practice Location Address Fax Number:
617-632-4850
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  160019 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160019 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9483 . This is a "HPHC DFCI ONLY" identifier . This identifiers is of the category "OTHER".
  • Identifier: J24682 . This is a "MA BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2938427 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6849485 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0191043 . This is a "MASSHEALTH MA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53264 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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