Provider Demographics
NPI:1376954719
Name:WAGGEL, STEPHANIE ELLEN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:WAGGEL
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:2201 COOPERATIVE WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3005
Mailing Address - Country:US
Mailing Address - Phone:646-776-0739
Mailing Address - Fax:
Practice Address - Street 1:2201 COOPERATIVE WAY STE 600
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3005
Practice Address - Country:US
Practice Address - Phone:646-776-0739
Practice Address - Fax:703-788-6867
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2017-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012603112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry