Provider Demographics
NPI:1609851609
Name:STEVENS, PATRICIA P (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4654
Mailing Address - Country:US
Mailing Address - Phone:540-371-3115
Mailing Address - Fax:540-372-9860
Practice Address - Street 1:1300 THORNTON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4654
Practice Address - Country:US
Practice Address - Phone:540-371-3115
Practice Address - Fax:540-372-9860
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021703207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54 1090968 02OtherSOUTHERN HEALTH
VA54 1090968OtherUNITED HEALTHCARE
VA54 1090968OtherUNITED HEALTHCARE
VA54 1090968 02OtherSOUTHERN HEALTH