Provider Demographics
NPI:1053502153
Name:STEPHEN O CHASTAIN MD PC
Entity Type:Organization
Organization Name:STEPHEN O CHASTAIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-683-4314
Mailing Address - Street 1:33 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4445
Mailing Address - Country:US
Mailing Address - Phone:978-683-3023
Mailing Address - Fax:978-691-5139
Practice Address - Street 1:33 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4445
Practice Address - Country:US
Practice Address - Phone:978-683-3023
Practice Address - Fax:978-691-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45089207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty