Provider Demographics
NPI:1982655759
Name:BORNSTEIN, STEVEN L (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:BORNSTEIN
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 1:969 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1555
Mailing Address - Country:US
Mailing Address - Phone:508-376-1125
Mailing Address - Fax:508-376-1102
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1555
Practice Address - Country:US
Practice Address - Phone:508-376-1125
Practice Address - Fax:508-376-1102
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159477207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3200582Medicaid
MAA3029901OtherPTAN
MAA3029901OtherPTAN