Provider Demographics
NPI:1467422493
Name:STOCKER, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:STOCKER
Suffix:
Gender:M
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:541 SUNSET LN
Practice Address - Street 2:STE 103
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3979
Practice Address - Country:US
Practice Address - Phone:540-321-3002
Practice Address - Fax:540-829-0019
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045405L207V00000X
VA0101261376207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050753Medicare PIN
F33577Medicare UPIN