Provider Demographics
NPI:1902868037
Name:STEPHENSON, THOMAS FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRANCIS
Last Name:STEPHENSON
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 1:324 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2732
Mailing Address - Country:US
Mailing Address - Phone:585-244-1475
Mailing Address - Fax:
Practice Address - Street 1:1160 CHILI AVE
Practice Address - Street 2:WESTSIDE IMAGING CENTER SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3035
Practice Address - Country:US
Practice Address - Phone:585-436-5225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1075912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00442764Medicaid
NY102160FFOtherPREFERRED CARE HMO
NY11963HMedicare ID - Type Unspecified
B76671Medicare UPIN