Provider Demographics
NPI:1861835340
Name:CALLOW, STEPHANIE LAUREN ROLLER (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN ROLLER
Last Name:CALLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7690 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6542
Mailing Address - Country:US
Mailing Address - Phone:513-475-8730
Mailing Address - Fax:513-475-8273
Practice Address - Street 1:7690 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-8730
Practice Address - Fax:513-475-8273
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351298322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology