Healthcare Provider Details

I. General information

NPI: 1326004169
Provider Name (Legal Business Name): STEVEN M BELANGER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE SUITE 301
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE SUITE 301
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-6204
  • Fax: 508-235-6360
Mailing address:
  • Phone: 508-235-6204
  • Fax: 508-235-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1998
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: