=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376530378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFAN G KAROS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 06/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MEMORIAL DR SUITE 104
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-466-4075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 MEMORIAL DR SUITE 104
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-798-1418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 73838
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------