Provider Demographics
NPI:1154322964
Name:SIMPSON, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:SIMPSON
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 1:198 GROTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1177
Mailing Address - Country:US
Mailing Address - Phone:978-862-0025
Mailing Address - Fax:978-862-0049
Practice Address - Street 1:198 GROTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1177
Practice Address - Country:US
Practice Address - Phone:978-862-0025
Practice Address - Fax:978-862-0049
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22501OtherBCBS
MA103355800OtherACS
MA6919759006OtherCIGNA
MA48317OtherFALLON
MA408251OtherTUFTS
MA0101877Medicaid
0900631OtherUNITED HEALTH
MA172414OtherHARVARD PILGRIM
MA2430200OtherAETNA
MA48317OtherFALLON
0900631OtherUNITED HEALTH
MA2430200OtherAETNA