Provider Demographics
NPI:1518916188
Name:EKSTROM, DEBORAH K (MD)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:K
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3160
Mailing Address - Country:US
Mailing Address - Phone:508-755-4825
Mailing Address - Fax:508-797-0167
Practice Address - Street 1:39 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3160
Practice Address - Country:US
Practice Address - Phone:508-755-4825
Practice Address - Fax:508-797-0167
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA117238OtherAETNA
MA1300139OtherUNITED HEALTHCARE
MA320430OtherCIGNA HEALTH
MA61333OtherFALLON HEALTHCARE
MA21055OtherHARVARD PILGRIM
MA711234OtherTUFTS
MA99165001OtherNETWORK HEALTH
MAM14797OtherBLUE SHIELD OF MA
MA61333OtherFALLON HEALTHCARE
MAA58658Medicare UPIN