Provider Demographics
NPI:1720423106
Name:STEPHENS, MALLORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:STEPHENS
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 1:6 OVERLOOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:603-569-6244
Mailing Address - Fax:
Practice Address - Street 1:6 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4842
Practice Address - Country:US
Practice Address - Phone:603-569-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-077349207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60-077349OtherNEW YORK STATE LICENSE NO.