Provider Demographics
NPI:1790717585
Name:STEVENS, RONALD L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:NEUROSURGERY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0631
Practice Address - Country:US
Practice Address - Phone:804-828-9165
Practice Address - Fax:804-828-0374
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23118Medicare UPIN