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
Fax: (617) 497-1190
Website:

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881960037 NPPES
Massachusetts MEDICAID 110146553A

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