Provider Demographics
NPI:1922545904
Name:STEDMAN, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:STEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 THURBER DR W
Mailing Address - Street 2:APT 14
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1285
Mailing Address - Country:US
Mailing Address - Phone:724-494-7764
Mailing Address - Fax:
Practice Address - Street 1:400 THURBER DR W
Practice Address - Street 2:APT 14
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1285
Practice Address - Country:US
Practice Address - Phone:724-494-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program