Provider Demographics
NPI:1922009265
Name:DEHAL, STACY ANN-MARIE (M D)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN-MARIE
Last Name:DEHAL
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7680
Mailing Address - Fax:704-316-7106
Practice Address - Street 1:7915 LAKE MANASSAS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3258
Practice Address - Country:US
Practice Address - Phone:571-261-3529
Practice Address - Fax:703-753-5613
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057518207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6211879Medicaid
160001538Medicare ID - Type Unspecified
G67444Medicare UPIN