Provider Demographics
NPI:1043284789
Name:STEVENSON, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OLD WEST ELM ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1731
Mailing Address - Country:US
Mailing Address - Phone:781-718-7435
Mailing Address - Fax:
Practice Address - Street 1:15 OLD WEST ELM ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1731
Practice Address - Country:US
Practice Address - Phone:781-202-9292
Practice Address - Fax:781-202-9299
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA68682OtherHPHC
MA0022761OtherNHP
MA3153550Medicaid
MA50600OtherFALLON
MA110177695OtherRR MEDICARE
MA7350955001OtherCIGNA
MAJ18925OtherBCBS
MA50600OtherFALLON