Healthcare Provider Details

I. General information

NPI: 1376505172
Provider Name (Legal Business Name): ERIC A. STEFFEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE OPHTHALMOLOGY
LEBANON NH
03756
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE OPHTHALMOLOGY
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5123
  • Fax: 651-738-6804
Mailing address:
  • Phone: 603-650-5123
  • Fax: 651-738-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19096
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47283
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: