Healthcare Provider Details

I. General information

NPI: 1164416483
Provider Name (Legal Business Name): DAVID STEBBINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE ROAD, PEQUOT BLDG STE 104
NORTH DARTMOUTH MA
02747
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-6650
  • Fax: 508-973-0345
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number80806
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: