MEDICARE: STEVEN VANDOR 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	207R00000X	Internal Medicine Physician	229703	MA

General Provider Information

NPI Number	:	1942217260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN VANDOR MD

Provider Business Mailing Address
First Line	:	29 CRAFTS ST
Second Line	:	SUITE 400
City	:	NEWTON
State	:	MA
Zip	:	02458-1275
Country	:	US
Telephone Number	:	617-964-7530
Fax Number	:	617-964-5479

Provider Business Practice Location Address
First Line	:	29 CRAFTS ST
Second Line	:	STE 400
City	:	NEWTON
State	:	MA
Zip	:	02458-1275
Country	:	US
Telephone Number	:	617-964-7530
Fax Number	:	617-964-5479

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/07/2023

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