Provider Demographics
NPI:1508875956
Name:DUBIN, STEPHEN ELLIOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ELLIOTT
Last Name:DUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CODDINGTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-471-2293
Mailing Address - Fax:617-471-1293
Practice Address - Street 1:67 CODDINGTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-471-2293
Practice Address - Fax:617-471-1293
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA584152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
22330OtherHARVARD PILGRIM
22093OtherBOSTON MEDICAL HEALTH NET
V06959OtherBCBS
MA3040518Medicaid
710697OtherTUFTS
V06959OtherBCBS
MA3040518Medicaid