Provider Demographics
NPI:1588659858
Name:GALIZIO, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:GALIZIO
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 1:555 TURNPIKE ST
Mailing Address - Street 2:SUITE 41
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5923
Mailing Address - Country:US
Mailing Address - Phone:978-681-4700
Mailing Address - Fax:978-681-6663
Practice Address - Street 1:555 TURNPIKE ST
Practice Address - Street 2:SUITE 41
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5923
Practice Address - Country:US
Practice Address - Phone:978-681-4700
Practice Address - Fax:978-681-6663
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206857207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0112101Medicaid
MAA31173Medicare PIN
MA0112101Medicaid