Provider Demographics
NPI:1477562593
Name:STEVENS, SUSAN M (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 KENNEDY MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-861-3338
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:180 KENNEDY MEMORIAL DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-5952
Practice Address - Fax:207-873-2952
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME281090099Medicaid
ME000937OtherANTHEM BC BS
E16132OtherHARVARD PILGRIM
ME1044339OtherAETNA
ME010474554OtherMEDNET
MEM56781OtherCIGNA
E16132OtherHARVARD PILGRIM
ME1044339OtherAETNA
E16132Medicare PIN