Basic Information
| Provider Information | |||||||||
| NPI: | 1306867833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT ST | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
| FaxNumber: | 4137941629 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 SARGENT ST | ||||||||
| Address2: | ROUTE 9 | ||||||||
| City: | BELCHERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010079881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133237212 | ||||||||
| FaxNumber: | 4139672524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 203189 | MA | X | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 203189 | MA | X | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.