Healthcare Provider Details

I. General information

NPI: 1265720858
Provider Name (Legal Business Name): STEVEN MAKOVITCH D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WELLS AVE
NEWTON MA
02459-3301
US

IV. Provider business mailing address

159 WELLS AVE
NEWTON MA
02459-3301
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-5777
  • Fax:
Mailing address:
  • Phone: 617-243-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248396
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number9382023-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number268772
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number268772
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: