Provider Demographics
NPI:1730473257
Name:STOVER, AMANDA RENO (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENO
Last Name:STOVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 LITHOPOLIS RD NW
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9585
Mailing Address - Country:US
Mailing Address - Phone:614-837-6363
Mailing Address - Fax:614-837-0425
Practice Address - Street 1:11925 LITHOPOLIS RD NW
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9585
Practice Address - Country:US
Practice Address - Phone:614-837-6363
Practice Address - Fax:614-837-0425
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-011416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107309Medicaid
OH0107309Medicaid