Provider Demographics
NPI:1457492498
Name:FITZ, STEPHANIE COFFMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:COFFMAN
Last Name:FITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 KENDERTON TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-2008
Mailing Address - Country:US
Mailing Address - Phone:937-429-2182
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-1921
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:937-534-1579
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-1132-F2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975100Medicaid
OHF12014141Medicare ID - Type Unspecified
OHF72309Medicare UPIN