Healthcare Provider Details

I. General information

NPI: 1831465525
Provider Name (Legal Business Name): MITCHELL STEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BROWN ST SUITE 204
HAVERHILL MA
01830-6778
US

IV. Provider business mailing address

77 WHEELER ST
GLOUCESTER MA
01930-1638
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-1939
  • Fax:
Mailing address:
  • Phone: 508-583-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: