Provider Demographics
NPI:1972549681
Name:SIMON, STEVEN R (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5444
Practice Address - Fax:781-431-5656
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-01-21
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Provider Licenses
StateLicense IDTaxonomies
MA151488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015333OtherNEIGHBORHOOD HEALTH
MA151488OtherTUFTS
MAJ18726OtherBLUE CROSS
MA3192687Medicaid
MAPV697OtherHARVARD PILGRIM
MAJ18726OtherBLUE CROSS
MAA28626Medicare ID - Type Unspecified