Provider Demographics
NPI:1073521753
Name:KAJENCKI, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:KAJENCKI
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 1:800 S MAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3144
Mailing Address - Country:US
Mailing Address - Phone:508-964-5560
Mailing Address - Fax:508-964-5570
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3144
Practice Address - Country:US
Practice Address - Phone:508-964-5560
Practice Address - Fax:508-964-5570
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB10041301OtherCIGNA
MA342OtherFALLON
MA725893OtherTUFTS
MAJ09823OtherMABC
202367OtherRI BLUE CHIP
0102003OtherUHC
MA7535OtherHPHC
MA3064565Medicaid
MAJ09823Medicare ID - Type Unspecified
202367OtherRI BLUE CHIP