Provider Demographics
NPI:1629187539
Name:ALLISON, STEPHANI RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANI
Middle Name:RENEE
Last Name:ALLISON
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 1:22 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9679
Mailing Address - Country:US
Mailing Address - Phone:302-226-0290
Mailing Address - Fax:302-644-1475
Practice Address - Street 1:424 SAVANNAH ROAD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021639Medicaid
DEG39521Medicare UPIN
DE1000021639Medicaid