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General NPI Number Information
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NPI Number | 1811985633
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Entity Type | Individual
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Provider Name | MARK STEPHAN OSTREM MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 54 MILLER ST SUITE 300
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City | QUINCY
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State | MA
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Zip | 02169-4725
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Country | US
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Telephone | 617-481-3300
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Fax | 617-481-3305
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Provider Business Mailing Address
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Address Line | 362 N BEDFORD ST
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City | EAST BRIDGEWATER
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State | MA
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Zip | 02333-1148
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Country | US
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Telephone | 617-481-3300
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Fax | 617-481-3305
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 44501
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License Number State | MA
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