Basic Information
| Provider Information | |||||||||
| NPI: | 1043284789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 250 POND ST | ||||||||
| Address2: | P.O. BOX 850981 | ||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021850981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818481300 | ||||||||
| FaxNumber: | 7813561829 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 POND ST | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021850981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818481300 | ||||||||
| FaxNumber: | 7813561829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 155843 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0022761 | 01 | MA | NHP | OTHER | 3153550 | 05 | MA | MEDICAID | 50600 | 01 | MA | FALLON | OTHER | 7350955001 | 01 | MA | CIGNA | OTHER | 68682 | 01 | MA | HPHC | OTHER | J18925 | 01 | MA | BCBS | OTHER |