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General NPI Number Information
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NPI Number | 1467947432
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Entity Type | Organization
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Legal Business Name | STEPHANIE M. OLIVA MD PC
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 10/14/2018
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Provider Practice Location Address
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Address Line | 10 RESEARCH PL STE 206
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City | NORTH CHELMSFORD
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State | MA
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Zip | 01863-2439
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Country | US
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Telephone | 978-275-1390
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Fax | 978-275-1394
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Provider Business Mailing Address
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Address Line | 35 UNITED DR STE 102
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City | WEST BRIDGEWATER
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State | MA
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Zip | 02379-1027
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Country | US
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Telephone | 508-238-8646
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Fax | 508-230-9772
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STEPHANIE M OLIVA
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Credential | MD
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Telephone | 609-744-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 269214
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License Number State | MA
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