MEDICARE: DR. MEKHALA STEPHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	213974	MA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	213974	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA42871	OTHER	MA	HARVARD PILGRIM
2	J27684	OTHER	MA	BLUE SHIELD
3	98014	OTHER	MA	FALLON
4	469489	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1023072287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEKHALA STEPHEN M.D.

Provider Business Mailing Address
First Line	:	163 LIBBEY PKWY
Second Line	:	SUITE 301
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3101
Country	:	US
Telephone Number	:	781-337-4224
Fax Number	:	781-335-0429

Provider Business Practice Location Address
First Line	:	163 LIBBEY PKWY
Second Line	:	SUITE 301
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3101
Country	:	US
Telephone Number	:	781-337-4224
Fax Number	:	781-335-0429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	10/30/2007

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Directions to “ DR. MEKHALA STEPHEN M.D.” Practice Location

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