Provider Demographics
NPI:1689711954
Name:STEIN, MICHAEL JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:STEIN
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 1:2 MANOR PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4871
Mailing Address - Country:US
Mailing Address - Phone:603-458-2233
Mailing Address - Fax:
Practice Address - Street 1:2 MANOR PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4871
Practice Address - Country:US
Practice Address - Phone:603-489-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine