1710038096 NPI number — JOHN STEDMAN DO

Table of content: JOHN STEDMAN DO (NPI 1710038096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710038096 NPI number — JOHN STEDMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEDMAN
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1710038096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 ANDERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-775-5671
Provider Business Mailing Address Fax Number:
207-871-1243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 ANDERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-775-5671
Provider Business Practice Location Address Fax Number:
207-871-1243
Provider Enumeration Date:
01/15/2007

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: 207Q00000X , with the licence number:  839 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002000 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M3330 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 155860099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 767587 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27205 . This is a "MARTINS POINT HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: D93041 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".




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