Provider Demographics
NPI:1295723450
Name:MOTT, STEPHEN HAMILTON (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HAMILTON
Last Name:MOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 REDHILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5518
Mailing Address - Country:US
Mailing Address - Phone:949-267-0400
Mailing Address - Fax:949-221-0004
Practice Address - Street 1:2500 REDHILL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5518
Practice Address - Country:US
Practice Address - Phone:949-267-0400
Practice Address - Fax:949-221-0004
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC188922084N0402X, 2084P0005X
NH146632084N0402X, 2084P0005X
CAC1506742084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295723450Medicaid
VT1016783Medicaid
NH30209003Medicaid
NH001298201Medicare PIN
F80829Medicare UPIN