Provider Demographics
NPI:1073133815
Name:PAVLOVICH, STEPHANIE SARAH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SARAH
Last Name:PAVLOVICH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SARAH
Other - Last Name:D'SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 MASON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4617
Mailing Address - Country:US
Mailing Address - Phone:984-974-4462
Mailing Address - Fax:919-843-9355
Practice Address - Street 1:102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4617
Practice Address - Country:US
Practice Address - Phone:984-974-4462
Practice Address - Fax:919-843-9355
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261116390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program