Basic Information
| Provider Information | |||||||||
| NPI: | 1114097599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STECKER | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 675 PARAMOUNT DR | ||||||||
| Address2: | STE 203 | ||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027675416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088800012 | ||||||||
| FaxNumber: | 5088800256 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 PARAMOUNT DR | ||||||||
| Address2: | STE 203 | ||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027675416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088800012 | ||||||||
| FaxNumber: | 5088800256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 215705 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 318796 | 01 | MA | AETNA | OTHER | 713631 | 01 | MA | HARVARD PILGRIM | OTHER | 2097010 | 05 | MA | MEDICAID | J25682 | 01 | MA | BCBS | OTHER | 215705 | 01 | MA | TUFTS | OTHER | 3796020 | 01 | MA | CIGNA | OTHER | 000000024762 | 01 | MA | BMC | OTHER |