Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101249196 | VA |
N | 2080P0208X | Pediatric Infectious Diseases | 0101249196 | VA |
NPI | 1043251499 |
---|---|
Provider Name | Ina Stephens |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22901-8303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043251499 | (05) | VA |
193271300 | (05) | MD |
G74896 | (02) | MD |