Provider Demographics
NPI:1922460906
Name:STOVALL, CAROLINE MICHAUX LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:MICHAUX LEWIS
Last Name:STOVALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:MICHAUX
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1525 WILSON BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2470
Mailing Address - Country:US
Mailing Address - Phone:703-966-7127
Mailing Address - Fax:
Practice Address - Street 1:1525 WILSON BLVD STE 125
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2470
Practice Address - Country:US
Practice Address - Phone:703-966-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101269135207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty