Healthcare Provider Details

I. General information

NPI: 1558450569
Provider Name (Legal Business Name): STEPHEN OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOSPITAL DR
BRIDGTON ME
04009-1167
US

IV. Provider business mailing address

25 HOSPITAL DR
BRIDGTON ME
04009-1167
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-4234
  • Fax: 207-647-6260
Mailing address:
  • Phone: 207-647-4234
  • Fax: 207-647-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number018543
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: