Provider Demographics
NPI:1235691049
Name:DORIS, STEPHANIE ERIN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERIN
Last Name:DORIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1583
Mailing Address - Country:US
Mailing Address - Phone:614-544-1000
Mailing Address - Fax:
Practice Address - Street 1:50 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1583
Practice Address - Country:US
Practice Address - Phone:614-544-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program