Basic Information
Provider Information | |||||||||
NPI: | 1952300089 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JONES | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 128 ROUTE 27 | ||||||||
Address2: |   | ||||||||
City: | RAYMOND | ||||||||
State: | NH | ||||||||
PostalCode: | 030771220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038953351 | ||||||||
FaxNumber: | 6038950773 | ||||||||
Practice Location | |||||||||
Address1: | 128 ROUTE 27 | ||||||||
Address2: |   | ||||||||
City: | RAYMOND | ||||||||
State: | NH | ||||||||
PostalCode: | 030771220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038953351 | ||||||||
FaxNumber: | 6038950773 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2005 | ||||||||
LastUpdateDate: | 03/06/2013 | ||||||||
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 | 10559 | NH | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 41515 | 01 | NH | CIGNA | OTHER | 191793903 | 01 | NH | UNITED HEALTHCARE | OTHER | 30200407 | 05 | NH |   | MEDICAID | 0107443YPNH01 | 01 | NH | ANTHEM | OTHER | AA14145 | 01 | NH | HARVARD PILGRIM | OTHER |