Provider Demographics
NPI:1528059003
Name:SWEET, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:SWEET
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:PO BOX 70266
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1577
Mailing Address - Country:US
Mailing Address - Phone:413-788-6530
Mailing Address - Fax:413-750-8027
Practice Address - Street 1:100 WASON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1119
Practice Address - Country:US
Practice Address - Phone:413-733-9666
Practice Address - Fax:413-750-3432
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38000207RN0300X
CT035747207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001987Medicaid
MA2055767Medicaid
CT003057346Medicaid
VT1001987Medicaid
CT390000118Medicare PIN
MA2055767Medicaid
B98968Medicare UPIN