Provider Demographics
NPI:1548203334
Name:HULL, STEPHEN Z (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Z
Last Name:HULL
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 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3000
Mailing Address - Fax:
Practice Address - Street 1:1364 CONGRESS ST
Practice Address - Street 2:UNIT 3
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2119
Practice Address - Country:US
Practice Address - Phone:207-400-5833
Practice Address - Fax:207-400-8560
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0114772081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM0726Medicare ID - Type Unspecified
MERX3645Medicare PIN
MEC66248Medicare UPIN