Provider Demographics
NPI:1043251499
Name:STEPHENS, INA (MD)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2335 SEMINOLE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8303
Practice Address - Country:US
Practice Address - Phone:434-924-9350
Practice Address - Fax:434-254-4491
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012491962080P0208X, 208000000X, 2080P0208X
MDD00431922080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043251499Medicaid
MD193271300Medicaid
VA1043251499Medicaid
MDS579169WMedicare PIN
MDS214Q374Medicare PIN
MD193271300Medicaid