Provider Demographics
NPI:1295015519
Name:PAINE, STEPHEN LORD (LAC, OMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LORD
Last Name:PAINE
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36 SPRING GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2622
Mailing Address - Country:US
Mailing Address - Phone:860-413-2118
Mailing Address - Fax:860-920-5216
Practice Address - Street 1:536 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2415
Practice Address - Country:US
Practice Address - Phone:860-413-2118
Practice Address - Fax:860-920-5216
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI265171100000X
CT512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist