Gannon, Stephen Andrew
Gannon, Stephen Andrew is an individual health care provider with primary practice located at 300 Mount Auburn St Ste 310 , Cambridge MA 02138-5665. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Internal Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Gannon, Stephen Andrew can be contacted via phone (617) 497-1560.Contact Information
Primary practice address
300 Mount Auburn St Ste 310
Cambridge MA 02138-5665
Phone: (617) 497-1560
Fax: (617) 497-1190
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | MD15347 | Rhode Island |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD15347 | Rhode Island |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 274883 | Massachusetts |
Profile Details
| NPI number | 1881960037 |
|---|---|
| LBN Legal business name | Gannon, Stephen Andrew |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2012 |
| Last updated | May 18th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881960037 | NPPES |
| Massachusetts | MEDICAID | 110146553A |
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