Provider Demographics
NPI:1932127677
Name:WINIKOFF, STEPHEN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:WINIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 8TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-845-1179
Mailing Address - Fax:
Practice Address - Street 1:426 8TH ST STE 204
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV229252086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KAV65OtherBLUE CROSS OF IDAHO
WA8458754Medicaid
000010158540OtherBLUE SHIELD OF IDAHO
0211573OtherLABOR & INDUSTRIES
7608856OtherAETNA
7676WIOtherASURIS NW HEALTH
WV22925OtherHEALTH PLAN OF THE UPPER
WV3810010434Medicaid
WA8458754Medicaid
7676WIOtherASURIS NW HEALTH
P00332465Medicare PIN
G8860998Medicare PIN