Provider Demographics
NPI:1891893178
Name:FABRY, STEPHEN CORVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CORVIN
Last Name:FABRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8744
Mailing Address - Fax:781-744-5669
Practice Address - Street 1:LAHEY CLINIC
Practice Address - Street 2:41 MALL ROAD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8744
Practice Address - Fax:781-744-5669
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA75813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3151581Medicaid
MAJ1406801Medicare PIN
MA3151581Medicaid