Healthcare Provider Details

I. General information

NPI: 1962492124
Provider Name (Legal Business Name): STEPHEN CHARLES KLEINMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 HIGH ST CTN CHARLESTOWN HEALTHCARE CENTER
CHARLESTOWN MA
02129-3026
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-8200
  • Fax: 617-726-3514
Mailing address:
  • Phone: 617-724-8200
  • Fax: 617-726-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37445
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: