Provider Demographics
NPI:1578540688
Name:VON STEIN, G. ALAN (MD)
Entity Type:Individual
Prefix:
First Name:G. ALAN
Middle Name:
Last Name:VON STEIN
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 1:1205 HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1737
Mailing Address - Country:US
Mailing Address - Phone:317-831-9469
Mailing Address - Fax:317-834-5928
Practice Address - Street 1:1205 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1737
Practice Address - Country:US
Practice Address - Phone:317-831-9469
Practice Address - Fax:317-834-5928
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040116A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000197303OtherANTHEM PIN
IN160020318Medicare PIN
IN000000197303OtherANTHEM PIN
IN277420AMedicare PIN