MEDICARE: MATTHEW STEVENS 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	293399	NY

General Provider Information

NPI Number	:	1154716041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW STEVENS M.D.

Provider Business Mailing Address
First Line	:	6687 PITTSFORD PALMYRA RD
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3403
Country	:	US
Telephone Number	:	585-678-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6687 PITTSFORD PALMYRA RD
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3403
Country	:	US
Telephone Number	:	585-678-8080
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	04/23/2025

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