Provider Demographics
NPI:1255306460
Name:STEPHENS, GREGORY T (M D)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9376 ATLEE STATION RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2602
Mailing Address - Country:US
Mailing Address - Phone:804-730-0990
Mailing Address - Fax:804-730-8752
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2602
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:804-730-8752
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5645603Medicaid
VA000225P96Medicare PIN
VAG28454Medicare UPIN