Provider Demographics
NPI:1821119124
Name:VERRAL, STEPHEN CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:VERRAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3304
Mailing Address - Country:US
Mailing Address - Phone:518-745-5280
Mailing Address - Fax:518-745-5284
Practice Address - Street 1:1 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3304
Practice Address - Country:US
Practice Address - Phone:518-745-5280
Practice Address - Fax:518-745-5284
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY243122-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02893323Medicaid