Provider Demographics
NPI:1356379648
Name:FLETCHER, H STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:H
Middle Name:STEPHEN
Last Name:FLETCHER
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 1:200 SOUTH ORANGE AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-322-7977
Mailing Address - Fax:973-322-7979
Practice Address - Street 1:200 SOUTH ORANGE AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-322-7977
Practice Address - Fax:973-322-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA026286002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2082501Medicaid
NJ147416Medicare ID - Type Unspecified
NJ2082501Medicaid