Provider Demographics
NPI:1023002219
Name:STEPHENSEN, SIGURDUR A (MD)
Entity type:Individual
Prefix:
First Name:SIGURDUR
Middle Name:A
Last Name:STEPHENSEN
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 1:931 CHATHAM LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2417
Mailing Address - Country:US
Mailing Address - Phone:614-457-4880
Mailing Address - Fax:614-457-4890
Practice Address - Street 1:931 CHATHAM LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2417
Practice Address - Country:US
Practice Address - Phone:614-457-4880
Practice Address - Fax:614-457-4890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053409207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0796821Medicaid
E76638Medicare UPIN
ST0674451Medicare ID - Type Unspecified