Healthcare Provider Details

I. General information

NPI: 1053755611
Provider Name (Legal Business Name): MARGO ROCKWELL STEVENSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGO ELIZABETH ROCKWELL D.O.

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 CHARLTON RD
STURBRIDGE MA
01566-1571
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 774-452-7200
  • Fax: 774-452-7193
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number274393
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number274393
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110110753A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: