Stephanie Lee Bivona, MD
Individual provider Active NPI Pediatrics Physician · Medford, MA
NPI 1336600279 · NPPES record last updated Jan 18, 2024
Key facts
- NPI
- 1336600279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 1016341 (MA)
- Practice address
- 101 Main St Ste 202
Medford, MA 02155-4530 - Phone
- (781) 396-1288
- NPI assigned
- Mar 25, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191010001512 | NY | Order and Referring Only - Pediatric Medicine |
5092046789 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1016341 | MA | MD | Pediatrics Physician |
| 315905 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates of Medford | Past | Accepting new patients |
Interoperability endpoints
- sbivona37269@direct.chppoc.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 315905 | NY | |
| Pediatrics Physician | 208000000X | 1016341 | MA | Yes |
Addresses
Primary practice location
101 Main St Ste 202
Medford, MA 02155-4530
Mailing address
101 Main St Ste 202
Medford, MA 02155-4530
Other providers in Medford, MA
- Robyn Lee Bianco
- Jennifer Bien-Aime
- Hannah Jolie Biggar
- Laura Bilodeau
- Bio-Medical Applications of Massachusetts, Inc.
- Rachel Dawn Biwer
- BJ'S Wholesale Club Inc.
- Stephanie S Bjork
- Rhonda Lee Black
- Theresa Blackman
All providers in Medford, MA · Pediatrics Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.