Provider Demographics
NPI:1417983651
Name:STEFAN, DOINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOINA
Middle Name:A
Last Name:STEFAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DOINA
Other - Middle Name:A
Other - Last Name:POPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-814-6724
Mailing Address - Fax:
Practice Address - Street 1:875 WESLEY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1613
Practice Address - Country:US
Practice Address - Phone:360-435-6525
Practice Address - Fax:360-435-2634
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8236655Medicaid
WAH02969Medicare UPIN
WAAB11211Medicare PIN