Individual
STEPHANIE LEE BIVONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 MAIN ST STE 202, MEDFORD, MA 02155-4530
(781) 396-1288
Mailing address
101 MAIN ST STE 202, MEDFORD, MA 02155-4530
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1016341
MA
208000000X
Pediatrics Physician
315905
NY
Other
Enumeration date
03/25/2019
Last updated
01/18/2024
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