Provider Demographics
NPI:1043236904
Name:STEVENS, SANDRA L (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2771
Mailing Address - Country:US
Mailing Address - Phone:207-373-6125
Mailing Address - Fax:207-245-7159
Practice Address - Street 1:81 MEDICAL CENTER DR STE 2100
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2771
Practice Address - Country:US
Practice Address - Phone:207-373-6125
Practice Address - Fax:207-245-7159
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16456207P00000X, 207PE0004X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400261354Medicare PIN
MEI09750Medicare UPIN