Provider Demographics
NPI:1518992965
Name:STEGMAN, R L (PHD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:L
Last Name:STEGMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3492
Mailing Address - Country:US
Mailing Address - Phone:937-298-6288
Mailing Address - Fax:937-298-6271
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-298-6288
Practice Address - Fax:937-298-6271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4057103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2520221Medicaid
OHQ23864Medicare UPIN
OH2520221Medicaid