MEDICARE: DR. MARK STEPHAN OSTREM MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	44501	MA

General Provider Information

NPI Number	:	1811985633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEPHAN OSTREM MD

Provider Business Mailing Address
First Line	:	362 N BEDFORD ST
Second Line	:
City	:	EAST BRIDGEWATER
State	:	MA
Zip	:	02333-1148
Country	:	US
Telephone Number	:	617-481-3300
Fax Number	:	617-481-3305

Provider Business Practice Location Address
First Line	:	54 MILLER ST
Second Line	:	SUITE 300
City	:	QUINCY
State	:	MA
Zip	:	02169-4725
Country	:	US
Telephone Number	:	617-481-3300
Fax Number	:	617-481-3305

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/15/2018

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