Provider Demographics
NPI:1447290408
Name:FORD, STEPHEN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 ST GEORGES AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3427
Mailing Address - Country:US
Mailing Address - Phone:732-382-5200
Mailing Address - Fax:732-382-5201
Practice Address - Street 1:1503 ST GEORGES AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3427
Practice Address - Country:US
Practice Address - Phone:732-382-5200
Practice Address - Fax:732-382-5201
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04794600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D06836Medicare UPIN
NJF0536535Medicare ID - Type Unspecified