Provider Demographics
NPI:1548416795
Name:RAGAN, STEPHEN TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TAYLOR
Last Name:RAGAN
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 1:3002 FINDLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2314
Mailing Address - Country:US
Mailing Address - Phone:706-627-4607
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD # HSCL3086
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-1511
Practice Address - Country:US
Practice Address - Phone:631-444-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00907172083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine