Healthcare Provider Details

I. General information

NPI: 1093949778
Provider Name (Legal Business Name): STEPHANIE S BJORK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST SUITE 217
MEDFORD MA
02155-4540
US

IV. Provider business mailing address

101 MAIN ST SUITE 217
MEDFORD MA
02155-4540
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-6000
  • Fax: 781-395-4703
Mailing address:
  • Phone: 781-395-6000
  • Fax: 781-395-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number257270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: