Healthcare Provider Details

I. General information

NPI: 1952358749
Provider Name (Legal Business Name): STEPHEN A ALSDORF M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 STOCKBRIDGE ROAD
GREAT BARRINGTON MA
01230
US

IV. Provider business mailing address

P.O. BOX 30
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-8580
  • Fax: 413-528-8583
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-644-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: