Provider Demographics
NPI:1770542656
Name:PEZZELLA, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:PEZZELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3130
Mailing Address - Fax:508-368-3133
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3130
Practice Address - Fax:508-368-3133
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39310207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
918138OtherFIRST HEALTH
042472266OtherONE HEALTH PLAN
26850OtherCHILDRENS MEDICAL SECURIT
5030238OtherAETNA US HEALTHCARE
N01759OtherMEDICARE B
060047286OtherRAILROAD MEDICARE
2070944OtherMEDICAID WELFARE
N01759OtherBLUE CARE ELECT
N01759OtherBLUE SHIELD HMO BLUE
N01759OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MANAGMEN
MA2070944Medicaid
4366873OtherCIGNA HEALTH PLAN
784067OtherMVP HEALTH CARE
26856OtherHEALTHY START
9900071OtherFALLON COMMUNITY HEALTH P
AA6084OtherHARVARD PILGRIM HEALTHCAR
N01759OtherBLUE SHIELD INDEMNITY
AA6084OtherHARVARD PILGRIM HEALTHCAR