Provider Demographics
NPI:1639168172
Name:MCELROY, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:MCELROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 414402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:866-898-1738
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:ATTN EMERGENCY DEPT
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:617-376-5549
Practice Address - Fax:617-376-5553
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157332207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3187055Medicaid
439434BMCOtherTUFTS
MAJ19488OtherBCBS
MAAA101472OtherPILGRIM HEALTH
MA792978OtherTUFTS
MA000000005693OtherBMC HEALTHNET
MA436432OtherHPHC
930103188Medicare PIN
439434BMCOtherTUFTS
MA3187055Medicaid
MA436432OtherHPHC
A2878402Medicare PIN