Provider Demographics
NPI:1982721148
Name:JOHN STEDMAN DO
Entity Type:Organization
Organization Name:JOHN STEDMAN DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-772-0211
Mailing Address - Street 1:192 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2428
Mailing Address - Country:US
Mailing Address - Phone:207-772-0211
Mailing Address - Fax:207-772-3896
Practice Address - Street 1:192 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2428
Practice Address - Country:US
Practice Address - Phone:207-772-0211
Practice Address - Fax:207-772-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S0939OtherANTHEM
M333OtherCIGNA
MED93041Medicare UPIN
M333OtherCIGNA