Provider Demographics
NPI:1295056000
Name:STECKER, ELISSA (MD,)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:STECKER
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 WAVERLEY OAKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8474
Mailing Address - Country:US
Mailing Address - Phone:781-647-6920
Mailing Address - Fax:781-891-0056
Practice Address - Street 1:355 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8474
Practice Address - Country:US
Practice Address - Phone:781-647-6920
Practice Address - Fax:781-891-0056
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine