Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 45089 | MA |
NPI | 1255356705 |
---|---|
Provider Name | Stephen Oliver Chastain |
First Address | Methuen, MA 01844-4445 |
Second Address | Methuen, MA 01844-4445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2075156 | (05) | MA |
70998 | HARVARD PILGRIM (01) | |
719498 | TUFT HEALTH PLAN (01) | |
80834 | FALLON HEALTH (01) | |
A54105 | (02) | MA |
D13207 | BC/BS (01) |