Provider Demographics
NPI:1689741738
Name:STEVENS, GARTH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:
Last Name:STEVENS
Suffix:JR
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 1:2924 EMERYWOOD PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3746
Mailing Address - Country:US
Mailing Address - Phone:804-330-9303
Mailing Address - Fax:804-330-9302
Practice Address - Street 1:2924 EMERYWOOD PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-3746
Practice Address - Country:US
Practice Address - Phone:804-330-9303
Practice Address - Fax:804-330-9302
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180041025OtherRAILROAD MEDICARE
VA006308287Medicaid
VA006308287Medicaid
VA180041025OtherRAILROAD MEDICARE