Provider Demographics
NPI:1427028810
Name:MARTIN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MARTIN
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 WORCESTER ROAD
Practice Address - Street 2:BARRE FAMILY HEALTH CENTER
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005
Practice Address - Country:US
Practice Address - Phone:978-355-6321
Practice Address - Fax:978-355-6549
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301128Medicaid
MA1301128Medicaid
A39033Medicare ID - Type Unspecified