Provider Demographics
NPI:1053755611
Name:STEVENSON, MARGO ROCKWELL (DO)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:ROCKWELL
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:ELIZABETH
Other - Last Name:ROCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:198 CHARLTON RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1571
Practice Address - Country:US
Practice Address - Phone:774-452-7200
Practice Address - Fax:774-452-7193
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274393208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110110753AMedicaid