Provider Demographics
NPI:1689673329
Name:LADSON-WOFFORD, STEPHANIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:E
Last Name:LADSON-WOFFORD
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 1:1272 W MAIN ST
Mailing Address - Street 2:DOCTORS PARK BLDG 5
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2004
Mailing Address - Country:US
Mailing Address - Phone:740-348-0003
Mailing Address - Fax:
Practice Address - Street 1:595 COPELAND MILL RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8908
Practice Address - Country:US
Practice Address - Phone:614-823-8500
Practice Address - Fax:614-823-8501
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057852207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0757453Medicaid
OH4127564Medicare PIN
OHE57711Medicare UPIN
OH4127566Medicare PIN
OH0757453Medicaid
OH4127565Medicare PIN
OH4127563Medicare PIN
OH0757453Medicaid
OH4127565Medicare PIN
OH4127564Medicare PIN
OH4127562Medicare PIN
OH4127563Medicare PIN