Provider Demographics
NPI:1376514596
Name:FLAX, STEPHEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:FLAX
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 1:1514 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2803
Mailing Address - Country:US
Mailing Address - Phone:540-667-4499
Mailing Address - Fax:540-722-4172
Practice Address - Street 1:1514 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2803
Practice Address - Country:US
Practice Address - Phone:540-667-4499
Practice Address - Fax:540-722-4172
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056865207ND0900X, 207NI0002X, 207NS0135X, 207N00000X, 207NI0002X, 207NS0135X
WV19832207NI0002X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5900003000Medicaid
VA005901570Medicaid
WV000859996OtherMTST BCBS
VA234870OtherANTHEM BCBS
VA234870OtherANTHEM BCBS
WVFL4029311Medicare ID - Type Unspecified
WV5900003000Medicaid