Provider Demographics
NPI:1922053610
Name:MELLER, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:MELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Mailing Address - Country:US
Mailing Address - Phone:508-853-2716
Mailing Address - Fax:508-856-9025
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-853-2716
Practice Address - Fax:508-856-9025
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA544422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE CHAMPUS
AA4452OtherHARVARD PILGRIM HEALTHCAR
28031OtherCHILDRENS MEDICAL SECURIT
784215OtherMVP HEALTH CARE
J14988OtherBLUE CARE ELECT
J14988OtherBLUE SHIELD HMO BLUE
3100456OtherMEDICAID WELFARE
9900044OtherFALLON COMMUNITY HEALTH P
5538230OtherAETNA US HEALTHCARE
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherTHREE RIVERS
1150172OtherFIRST HEALTH
28031OtherHEALTHY START
042472266OtherONE HEALTH PLAN
MA3100456Medicaid
1635232OtherCIGNA HEALTH PLAN
J14988OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MANAGEME
MA3100456Medicaid