Provider Demographics
NPI:1356669188
Name:STEVENS, ERIN E (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2957
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-2957
Practice Address - Fax:614-685-6533
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1351207RG0300X, 207R00000X
OH34.014579207R00000X, 207RH0002X
MA260331207R00000X, 207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408341Medicaid