Provider Demographics
NPI:1215027115
Name:CONTI, STEPHEN M (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:CONTI
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 1:4676 DOUGLAS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3619
Mailing Address - Country:US
Mailing Address - Phone:330-494-1116
Mailing Address - Fax:330-494-0276
Practice Address - Street 1:4676 DOUGLAS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3619
Practice Address - Country:US
Practice Address - Phone:330-494-1116
Practice Address - Fax:330-494-0276
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122579207W00000X
PAMD450342207WX0107X
OH35.122579207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104485Medicaid
PAMD450342OtherLICENSE
IL0361168601Medicaid
OH35-122579OtherLICENSE
IL036116860OtherLICENSE NUMBER
IL05626127OtherBLUE CROSS BLUE SHIELD GP
PA1028956360001Medicaid
IL214342Medicare PIN
IL214343Medicare PIN
IL036116860OtherLICENSE NUMBER