Provider Demographics
NPI:1386626679
Name:STEPHEN, ANTONIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:ELIZABETH
Last Name:STEPHEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-0531
Mailing Address - Fax:617-724-3895
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:SURGICAL ONCOLOGY ASSOCIATES YAW 7B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-0531
Practice Address - Fax:617-724-3895
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-07-30
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Provider Licenses
StateLicense IDTaxonomies
MA160829208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27326OtherBCBS MA
MA760800OtherTUFTS HEALTH PLAN
MA2041031Medicaid
MAA37115Medicare ID - Type Unspecified
MA760800OtherTUFTS HEALTH PLAN