Provider Demographics
NPI:1033151360
Name:KOELBEL, STEPHEN F (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:KOELBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-682-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158723208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA68790OtherHARVARD PILGRIM HEALTHCAR
MA3188027Medicaid
MA158723OtherTUFTS HEALTH CARE
MAJ19651OtherBLUE CROSS BLUE SHIELD
G57421Medicare UPIN
A28964Medicare ID - Type Unspecified