Healthcare Provider Details

I. General information

NPI: 1144209685
Provider Name (Legal Business Name): STEPHEN JOSEPH POOR III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

1 EDWARD ST
CANTON MA
02021-2303
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-8001
  • Fax: 978-250-4142
Mailing address:
  • Phone: 781-828-3533
  • Fax: 781-828-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31356
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: