Provider Demographics
NPI:1992700702
Name:WIENER, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-314-6900
Mailing Address - Fax:
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-314-6900
Practice Address - Fax:603-314-6909
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216277207RG0100X
NH17094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA29-00971OtherEVECARE
NV30203516OtherNEW HAMPSHIRE MEDICAID
MA3293619OtherAETNA NON HMO
MA100017308OtherRAILROAD MEDICARE
MAJ25807OtherBLUE CROSS BLUE SHIELD
0029867OtherNEIGHBORHOOD HEALTH PLAN
MA1992700702OtherFALLON COMMUNITY HEALTH PLAN
MA110033133AMedicaid
MA216277OtherTUFTS HEALTH PLAN
MA305055OtherHARVARD PILGRIM HEALTHCAR
678864OtherHEALTHSOURCE
NHH77217OtherANTHEM BLUE CROSS
MA1992700702OtherAETNA HMO
4438055OtherCIGNA
972177OtherNETWORK HEALTH
NV30203516OtherNEW HAMPSHIRE MEDICAID
MA110033133AMedicaid