Provider Demographics
NPI:1366044836
Name:STELWIN MEDICAL PLLC
Entity Type:Organization
Organization Name:STELWIN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGWIM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:617-943-5606
Mailing Address - Street 1:19 F B MERRICK CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2477
Mailing Address - Country:US
Mailing Address - Phone:617-943-5606
Mailing Address - Fax:
Practice Address - Street 1:19 F B MERRICK CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2477
Practice Address - Country:US
Practice Address - Phone:617-943-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty