Provider Demographics
NPI:1710969670
Name:SMITH, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-829-6765
Mailing Address - Fax:508-829-6235
Practice Address - Street 1:27 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1842
Practice Address - Country:US
Practice Address - Phone:508-829-6765
Practice Address - Fax:508-829-6235
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA72499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherHEALTHCARE VALUE MANAGEME
9900105OtherFALLON COMMUNITY HEALTH P
J10107OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
1061437OtherFIRST HEALTH
5685498OtherAETNA US HEALTHCARE
080129482OtherRAILROAD MEDICARE
27089OtherCHILDRENS MEDICAL SECURIT
J10107OtherBLUE CARE ELECT
J10107OtherMEDICARE B
01 00295OtherEVERCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
9515211OtherCIGNA HEALTH PLAN
AA1186OtherHARVARD PILGRIM HEALTHCAR
3100171OtherMEDICAID WELFARE
27089OtherHEALTHY START
784198OtherMVP HEALTH CARE
J10107OtherBLUE SHIELD INDEMNITY
AA1186OtherHARVARD PILGRIM HEALTHCAR
J10107Medicare ID - Type Unspecified