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General NPI Number Information
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NPI Number | 1477562593
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Entity Type | Individual
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Provider Name | SUSAN M. STEVENS D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 180 KENNEDY MEMORIAL DRIVE SUITE 303
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City | WATERVILLE
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State | ME
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Zip | 04901
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Country | US
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Telephone | 207-872-5952
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Fax | 207-873-2952
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Provider Business Mailing Address
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Address Line | 174 KENNEDY MEMORIAL DRIVE
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City | WATERVILLE
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State | ME
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Zip | 04901
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Country | US
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Telephone | 207-861-3338
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Fax | 207-861-3281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1216
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License Number State | ME
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