Healthcare Provider Details

I. General information

NPI: 1083099162
Provider Name (Legal Business Name): JACQUELINE STEPHEN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 POND AVE
BROOKLINE MA
02445-7170
US

IV. Provider business mailing address

1180 BEACON ST STE 3D
BROOKLINE MA
02446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-0202
  • Fax: 720-361-7739
Mailing address:
  • Phone: 617-232-0202
  • Fax: 720-361-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE ANTONIA STEPHEN
Title or Position: PHYSICIAN
Credential: M.D
Phone: 617-232-0202