Provider Demographics
NPI:1528032646
Name:KING, STELLA O (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:O
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:601 ELMWOOD AVE, BOX PSYCH
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0002
Mailing Address - Country:US
Mailing Address - Phone:585-279-4999
Mailing Address - Fax:585-473-5152
Practice Address - Street 1:2613 WEST HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2327
Practice Address - Country:US
Practice Address - Phone:585-279-4999
Practice Address - Fax:585-473-5152
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03328021Medicaid
H23976Medicare UPIN
NY03328021Medicaid