Provider Demographics
NPI:1275943730
Name:MOELLER, STEFANIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARIE
Last Name:MOELLER
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 1:542 W KREMER HOYING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9708
Mailing Address - Country:US
Mailing Address - Phone:419-305-0095
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131882207R00000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program