Provider Demographics
NPI:1184690612
Name:MEISTER, STEPHEN J (MD, MHSA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MEISTER
Suffix:
Gender:M
Credentials:MD, MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2615
Mailing Address - Country:US
Mailing Address - Phone:207-621-9337
Mailing Address - Fax:207-621-3609
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-623-6500
Practice Address - Fax:207-621-5504
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014271208000000X
MEMD142712080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME301780099Medicaid
MEF11734Medicare UPIN
MEQX8291Medicare PIN
MEMM7572Medicare ID - Type Unspecified