Provider Demographics
NPI:1447238928
Name:JENKINS, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:JENKINS
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 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9400
Mailing Address - Fax:978-287-9408
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6186866Medicaid
MA0016159OtherNEIGHBORHOOD HEALTH
MA7793OtherHARVARD PILGRIM
MAB10207702OtherCIGNA
MA1202094OtherUNITED HEALTHCARE
MAJ03363OtherBLUE CROSS
MA4019954OtherAETNA
MA702904OtherTUFTS
MA702904OtherTUFTS
MAJ03363Medicare ID - Type Unspecified