Provider Demographics
NPI:1457388696
Name:STEVENSON, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:STEVENSON
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 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1930
Practice Address - Country:US
Practice Address - Phone:508-393-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2239492084S0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3951196OtherAETNA
1435770OtherCIGNA HEALTH PLAN
470391OtherTUFTS HEALTH PLAN
92687OtherFALLON COMM HEALTH PLAN
AA37555OtherHARVARD PILGRAM HLTH CARE
2104211OtherMEDICAID WELFARE
56300014OtherFIRST HEALTH
MA2104211Medicaid
3951196OtherUS HEALTHCARE
J29087QOtherBLUE CARE ELECT
384187OtherMVP HEALTH CARE
38797OtherCHILDRENS MED SEC PLAN
0103069OtherEVERCARE
38797OtherHEALTHY START
92687OtherFALLON COMM HEALTH PLAN
3951196OtherAETNA
3951196OtherUS HEALTHCARE