Provider Demographics
NPI:1467110890
Name:BAZILME, STEPHEN FILS (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN FILS
Middle Name:
Last Name:BAZILME
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12758 WOOD HOLLOW DR APT 1721
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6545
Mailing Address - Country:US
Mailing Address - Phone:561-331-7471
Mailing Address - Fax:
Practice Address - Street 1:12758 WOOD HOLLOW DR APT 1721
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6545
Practice Address - Country:US
Practice Address - Phone:561-331-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000683-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant