Provider Demographics
NPI:1467421800
Name:SALLAN, STEPHEN E (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:SALLAN
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 1:450 BROOKLINE AVE
Mailing Address - Street 2:ROOM 1642
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-3316
Mailing Address - Fax:617-632-5511
Practice Address - Street 1:450 BROOKLINE AVENUE
Practice Address - Street 2:ROOM 1642
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5450
Practice Address - Country:US
Practice Address - Phone:617-632-3316
Practice Address - Fax:617-632-5511
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA331962080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
23315OtherFALLON COMMUNITY HEALTH P
D88890DFOtherHCHC DFCI ONLY
033196OtherTUFTS
MA2042894OtherMASSHEALTH
2937823OtherAETNA US HEALTHCARE
4149019OtherCIGNA
000000025975OtherBMC HEALTHNET
MAM08754OtherBCBS INDEMNITY ELECT HMO
D88890DFOtherHCHC DFCI ONLY
MAM08754OtherBCBS INDEMNITY ELECT HMO