Provider Demographics
NPI:1124105960
Name:ZORA, STEFAN (MD)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:ZORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CENTRAL ST.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-744-8670
Mailing Address - Fax:978-744-8777
Practice Address - Street 1:20 CENTRAL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3739
Practice Address - Country:US
Practice Address - Phone:978-744-8670
Practice Address - Fax:978-744-8777
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA455492084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD17053Medicare ID - Type Unspecified