Basic Information
Provider Information | |||||||||
NPI: | 1154321875 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESRICK | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | B. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5700 | ||||||||
Address2: |   | ||||||||
City: | BELFAST | ||||||||
State: | ME | ||||||||
PostalCode: | 049155700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8664314077 | ||||||||
FaxNumber: | 4137747448 | ||||||||
Practice Location | |||||||||
Address1: | 70 MAIN ST | ||||||||
Address2: | NORTHAMPTON HEALTH CENTER | ||||||||
City: | FLORENCE | ||||||||
State: | MA | ||||||||
PostalCode: | 010621466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135868400 | ||||||||
FaxNumber: | 4135855435 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2005 | ||||||||
LastUpdateDate: | 04/17/2013 | ||||||||
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 | 70321 | MA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 2345689 | 01 | MA | AETNA | OTHER | 736419-7908 | 01 | MA | CONNECTICARE | OTHER | 102721 | 01 | MA | CIGNA | OTHER | 52822 | 01 | MA | FALLON | OTHER | 000000008362 | 01 | MA | BMC | OTHER | J09123 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER | 070321 | 01 | MA | TUFTS | OTHER | 24194 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 710702 | 01 | MA | HARVARD PILGRIM HEALTH PLAN | OTHER | 2212031 02 | 01 | MA | UNITED HEALTH PLAN | OTHER | 3055698 | 05 | MA |   | MEDICAID |