1457694218 NPI number — DR. ELLEN MARTHA STEIN M.D.

Table of content: DR. ELLEN MARTHA STEIN M.D. (NPI 1457694218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457694218 NPI number — DR. ELLEN MARTHA STEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
ELLEN
Provider Middle Name:
MARTHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1457694218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MSC EMERGENCY DEPARTMENT
Provider Second Line Business Mailing Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
85131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-9432
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-354-5454
Provider Business Practice Location Address Fax Number:
603-354-6535
Provider Enumeration Date:
03/30/2013

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: 207P00000X , with the licence number:  MD2019-0234 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 17659 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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