Provider Demographics
NPI:1447213939
Name:JENDZEJEC, STEPHEN M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:JENDZEJEC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:127 LONG SANDS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1158
Mailing Address - Country:US
Mailing Address - Phone:207-363-8430
Mailing Address - Fax:207-351-3006
Practice Address - Street 1:127 LONG SANDS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1158
Practice Address - Country:US
Practice Address - Phone:207-363-8430
Practice Address - Fax:207-351-3006
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010467585OtherAETNA HMO
596163OtherAETNA NONHMO GROUP
080140515OtherRAILROAD MEDICARE
3646359OtherCIGNA HEALTHCARE
MM2427OtherMEDICARE B
010467585OtherCHAMPUS
0405236YPME01OtherANTHEM BCBS NEW HAMPSHIRE
283840099OtherPRIMECARE MEDICAID
596163OtherAETNA HMO GROUP
E10019OtherHARVARD PILGRIM
010467585OtherAETNA NONHMO
YORK083565OtherANTHEM BCBS NEW HAMPSHIRE
010467585OtherSTANDARD TAX ID
ME283840099Medicaid
003689OtherANTHEM BLUE CROSS BLUE SH
010467585OtherMACHIGONNE
010467585001OtherANTHEM BLUE CROSS BLUE SH
596163OtherAETNA NONHMO GROUP
MM2427Medicare ID - Type Unspecified