Individual
DR. STEPHAN WICKY VAN DOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-5774
(774) 441-8443
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
223840
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110040985A
—
MA
05
—
2103923
—
MA
01
—
213058
TUFTS HEALTH PLAN
MA
01
—
J26427
BCBS OF MA
MA
Enumeration date
11/02/2005
Last updated
06/01/2021
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