Provider Demographics
NPI:1912075706
Name:BUZZELL, STEPHEN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HENRY
Last Name:BUZZELL
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 1:452 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1263
Mailing Address - Country:US
Mailing Address - Phone:603-924-7191
Mailing Address - Fax:603-924-4644
Practice Address - Street 1:452 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1263
Practice Address - Country:US
Practice Address - Phone:603-924-7191
Practice Address - Fax:603-924-4644
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008472Medicaid
F44160Medicare UPIN