Provider Demographics
NPI:1811973308
Name:FLOOD, STEVEN C (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:FLOOD
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 1:77 WARREN STREET
Mailing Address - Street 2:PROVIDER ENROLLMENT, 3RD FLOOR
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5359
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:70 WALNUT STREET
Practice Address - Street 2:FOXBORO AREA HEALTH CENTER
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:508-543-6371
Practice Address - Fax:508-543-3347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3119297Medicaid
MAFLK13008Medicare ID - Type Unspecified
MA3119297Medicaid