Provider Demographics
NPI:1114952587
Name:MARIONEAUX, STEPHANIE JONES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JONES
Last Name:MARIONEAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:JONES
Other - Last Name:MARIONEAUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1013 EDEN WAY N
Mailing Address - Street 2:STE E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2792
Mailing Address - Country:US
Mailing Address - Phone:757-547-5805
Mailing Address - Fax:757-547-1903
Practice Address - Street 1:1013 EDEN N WAY E
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2792
Practice Address - Country:US
Practice Address - Phone:757-547-5805
Practice Address - Fax:757-547-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA41299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6029760001Medicare NSC
VAE44342Medicare UPIN
VA1114952587Medicare PIN