Individual
DR. STEPHEN TAKEO NISHIYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 SECOND AVE, STE 400, WALTHAM, MA 02451
(781) 487-4340
(781) 487-4341
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(781) 487-4340
(781) 487-4341
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
81412
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081412
TUFTS HEALTH PLAN
MA
05
—
3141683
—
MA
01
—
J31669
BCBS MA
MA
Enumeration date
10/31/2005
Last updated
01/03/2013
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