Individual
STEPHEN M PEZZELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 SUMMER ST, WORCESTER, MA 01608
(508) 368-3130
(508) 368-3133
Mailing address
630 PLANTATION ST, WORCESTER, MA 01605
(508) 368-3130
(508) 368-3133
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
39310
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
PRIVATE HEALTHCARE SYSTEM
—
01
—
060047286
RAILROAD MEDICARE
—
01
—
2070944
MEDICAID WELFARE
—
05
—
2070944
—
MA
01
—
26850
CHILDRENS MEDICAL SECURIT
—
01
—
26856
HEALTHY START
—
01
—
4366873
CIGNA HEALTH PLAN
—
01
—
5030238
AETNA US HEALTHCARE
—
01
—
784067
MVP HEALTH CARE
—
01
—
918138
FIRST HEALTH
—
01
—
9900071
FALLON COMMUNITY HEALTH P
—
01
—
AA6084
HARVARD PILGRIM HEALTHCAR
—
01
—
N01759
MEDICARE B
—
Enumeration date
03/21/2006
Last updated
02/20/2009
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