Provider Demographics
NPI:1447206214
Name:VAN DAM, STEVEN H (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:VAN DAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 CHESTNUT ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2497
Mailing Address - Country:US
Mailing Address - Phone:781-559-0230
Mailing Address - Fax:781-559-0231
Practice Address - Street 1:300 CHESTNUT ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2497
Practice Address - Country:US
Practice Address - Phone:781-559-0230
Practice Address - Fax:781-559-0231
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA205080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0101150Medicaid
H18811Medicare UPIN
MA0101150Medicaid