Provider Demographics
NPI:1982664181
Name:STEVENS, RALPH A II (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:STEVENS
Suffix:II
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 1:1249 15TH ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-691-8500
Mailing Address - Fax:304-691-8510
Practice Address - Street 1:1249 15TH ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-8500
Practice Address - Fax:304-691-8510
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10493207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64177850Medicaid
OH0589831Medicaid
WV0087113000Medicaid
WV0445174Medicare ID - Type Unspecified
KY64177850Medicaid