Provider Demographics
NPI:1275519654
Name:STEVENS, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:9166 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:VA
Practice Address - Zip Code:22844-9422
Practice Address - Country:US
Practice Address - Phone:540-459-1380
Practice Address - Fax:540-459-1349
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056858207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006405100Medicaid
VA930002081Medicare ID - Type Unspecified
VA006405100Medicaid