Provider Demographics
NPI:1528263472
Name:PHILIP C. STEBBINS
Entity type:Organization
Organization Name:PHILIP C. STEBBINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-401-6109
Mailing Address - Street 1:184 MAMMOTH RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3254
Mailing Address - Country:US
Mailing Address - Phone:603-965-4473
Mailing Address - Fax:978-299-0121
Practice Address - Street 1:184 MAMMOTH RD
Practice Address - Street 2:SUITE D
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3254
Practice Address - Country:US
Practice Address - Phone:603-965-4473
Practice Address - Fax:978-299-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH6432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18586OtherBCBSMA GROUP
NH30212761Medicaid
MAM18586OtherBCBSMA GROUP
NH30212761Medicaid