Individual
MATTHEW LEE STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7800
(207) 956-6676
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
30036
SC
2085R0202X
Diagnostic Radiology Physician
49955
TN
2085R0202X
Diagnostic Radiology Physician
Primary
MD22755
ME
2085R0202X
Diagnostic Radiology Physician
ME111863
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005948100
—
FL
01
—
P01237985
RAILROAD MEDICARE
TN
05
—
Q001107
—
TN
Enumeration date
02/22/2011
Last updated
06/05/2019
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