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NPI Code Detail

MEDICARE: STEPHEN CRAIG ELLEN M.D.

MEDICARE:   STEPHEN CRAIG  ELLEN  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
12084P0800XPsychiatry Physician73606MA

General Provider Information

NPI Number : 1700825791
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN CRAIG ELLEN M.D.
Provider Business Mailing Address
First Line : 115 PAGE RD
Second Line :
City : BEDFORD
State : MA
Zip : 01730-1817
Country : US
Telephone Number : 603-883-0005
Fax Number :
Provider Business Practice Location Address
First Line : 1 MAIN ST
Second Line :
City : NASHUA
State : NH
Zip : 03064-2716
Country : US
Telephone Number : 603-883-0005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/08/2007

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