Provider Demographics
NPI:1710038096
Name:STEDMAN, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STEDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2545
Mailing Address - Country:US
Mailing Address - Phone:207-775-5671
Mailing Address - Fax:207-871-1243
Practice Address - Street 1:250 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2545
Practice Address - Country:US
Practice Address - Phone:207-775-5671
Practice Address - Fax:207-871-1243
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002000OtherANTHEM
M3330OtherCIGNA
ME155860099Medicaid
767587OtherTUFTS
27205OtherMARTINS POINT HEALTHCARE
D93041OtherHARVARD PILGRIM HEALTHCAR
ME002000OtherANTHEM
ME155860099Medicaid