Provider Demographics
NPI:1194043265
Name:VERLEGER, STEPHANIE SUSAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:VERLEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:SUSAN
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:59 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-2400
Mailing Address - Fax:518-581-0141
Practice Address - Street 1:59 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-2400
Practice Address - Fax:518-581-0141
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71833207V00000X
NY293941207V00000X
NY293941-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05314374Medicaid