Provider Demographics
NPI:1417904178
Name:LOFGREN, STEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEN
Middle Name:B
Last Name:LOFGREN
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 1:1264 MAIN ST
Mailing Address - Street 2:# 12
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1264 MAIN ST
Practice Address - Street 2:# 12
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3027
Practice Address - Country:US
Practice Address - Phone:978-369-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA346282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA617040OtherTUFTS HEALTH PLAN
MAM08968OtherBCBSMA
MAB75916Medicare UPIN
M08968Medicare PIN