Provider Demographics
NPI:1134174055
Name:PLEDGER, STEPHEN ROY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROY
Last Name:PLEDGER
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 1:5900 LONG MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9687
Mailing Address - Country:US
Mailing Address - Phone:513-420-3773
Mailing Address - Fax:513-727-2539
Practice Address - Street 1:5900 LONG MEADOW DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9687
Practice Address - Country:US
Practice Address - Phone:513-420-3773
Practice Address - Fax:513-727-2539
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-033951207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333151Medicaid
OH0333151Medicaid
OH0388753Medicare PIN
OHE51825Medicare UPIN
OHH003690Medicare PIN