Healthcare Provider Details

I. General information

NPI: 1427412030
Provider Name (Legal Business Name): STEPHANIE STEPHANIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SANDERSON STREET
GREENFIELD MA
01301-2778
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2655
  • Fax: 413-773-2629
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1021615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: