Provider Demographics
NPI:1548252802
Name:OZAROFF, STEPHEN D (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:OZAROFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2517
Mailing Address - Country:US
Mailing Address - Phone:978-685-1770
Mailing Address - Fax:978-682-5787
Practice Address - Street 1:150 PARK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2517
Practice Address - Country:US
Practice Address - Phone:978-685-1770
Practice Address - Fax:978-682-5787
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62429Medicare UPIN
MAAP2219Medicare ID - Type Unspecified