Provider Demographics
NPI:1306855002
Name:AUSBAND, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:AUSBAND
Suffix:
Gender:M
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:CRMH 1 SOUTH
Mailing Address - Street 2:PO BOX 1367
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24033-3367
Mailing Address - Country:US
Mailing Address - Phone:540-853-0824
Mailing Address - Fax:
Practice Address - Street 1:CRMH 1 SOUTH
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24033-3367
Practice Address - Country:US
Practice Address - Phone:540-853-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 96-01187171000000X, 207P00000X
SC29102207P00000X
VA0101240947207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306855002Medicaid
VA1306855002Medicaid
015155C47Medicare PIN