Provider Demographics
NPI:1083099162
Name:JACQUELINE STEPHEN MD LLC
Entity Type:Organization
Organization Name:JACQUELINE STEPHEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-232-0202
Mailing Address - Street 1:1180 BEACON ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3806
Mailing Address - Country:US
Mailing Address - Phone:617-232-0202
Mailing Address - Fax:720-361-7739
Practice Address - Street 1:55 POND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7170
Practice Address - Country:US
Practice Address - Phone:617-232-0202
Practice Address - Fax:720-361-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty