Provider Demographics
NPI:1407964281
Name:COGAN-LEVY, STEPHANIE LEE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:COGAN-LEVY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE 510S
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-434-6130
Mailing Address - Fax:314-434-1277
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:STE 501S
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-739-8844
Practice Address - Fax:314-739-5431
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-04-28
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Provider Licenses
StateLicense IDTaxonomies
MO2005038614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77020Medicare UPIN
MO938920816Medicare PIN