Healthcare Provider Details

I. General information

NPI: 1659767986
Provider Name (Legal Business Name): STEPHAN GOUPIL D.O., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LITTLETON RD STE 202
WESTFORD MA
01886-3198
US

IV. Provider business mailing address

133 LITTLETON RD STE 202
WESTFORD MA
01886-3198
US

V. Phone/Fax

Practice location:
  • Phone: 978-577-1946
  • Fax: 978-692-4716
Mailing address:
  • Phone: 978-577-1946
  • Fax: 978-692-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number264501
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number273177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: