Provider Demographics
NPI:1982865564
Name:MIDGLEY, STEPHANIE G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:MIDGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:G
Other - Last Name:SIPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2501
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01320207P00000X
NY269408207P00000X
RIMD13926207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1982865564OtherNHPRI
RISM89249Medicaid
MA110093094AMedicaid
RI1982865564OtherTUFTS HEALTH PLAN
RI1982865564OtherHEALTHNET FED SERVICES
RI1982865564OtherBCBS
RI1982865564OtherTUFTS HEALTH PLAN