Provider Demographics
NPI:1780661652
Name:MILHOAN, STEVAN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVAN
Middle Name:J
Last Name:MILHOAN
Suffix:
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 1:2200 GRAND CENTRAL AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1300
Mailing Address - Country:US
Mailing Address - Phone:304-295-9000
Mailing Address - Fax:304-295-0605
Practice Address - Street 1:2200 GRAND CENTRAL AVE
Practice Address - Street 2:STE 110
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1300
Practice Address - Country:US
Practice Address - Phone:304-295-9000
Practice Address - Fax:304-295-0605
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15193207P00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721378OtherBC/BS
WV0074018000Medicaid
OH0853250Medicaid
WVP00402249Medicare PIN
WVMI0682872Medicare PIN
WV0074018000Medicaid
OH0853250Medicaid