Provider Demographics
NPI:1578543880
Name:HEACOX, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:HEACOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-5011
Practice Address - Country:US
Practice Address - Phone:508-273-1980
Practice Address - Fax:508-295-9467
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52343207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110042618AMedicaid
MA110042618AMedicaid
MA09-00292OtherUNITEDHEALTHCARE
MA45183OtherCHILDRENS MEDICAL SECURIT
MA3002942Medicaid
MA052343OtherTUFTS HEALTH PLAN
MAJ03278OtherBCBS OF MASSACHUSETTS
MA000000023728OtherBOSTON MEDICAL CENTER HEA
MAB20458201OtherCIGNA
MAA56975Medicare UPIN
MA200016202OtherRAILROAD MEDICARE
MAJ03278Medicare ID - Type Unspecified