Provider Demographics
NPI:1134195159
Name:MEDLIN, STEPHEN C (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:MEDLIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8081 INNOVATION PARK DR FL 4
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-1390
Practice Address - Fax:571-472-1391
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-06-29
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Provider Licenses
StateLicense IDTaxonomies
SD6042207RH0000X
WI44942207RH0000X
OH34.010546207RH0000X
VA0102207694207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN214D7MEOtherCC SYSTEMS/ BLUE PLUS
SD3600766OtherMEDICA
SD253094OtherMIDLANDS CHOICE
MN92411422911OtherPRIMEWEST
IA1134195159Medicaid
MN214D7MEOtherBLUE CROSS
SD370624200OtherDEPT OF LABOR
SD57105AH10OtherWPS TRICARE
SD6631870Medicaid
SD678061051266OtherPREFERRED ONE
SDHP79180OtherHEALTHPARTNERS
SD1134195159OtherARAZ/ AMERICA'S PPO
SD4993050OtherBLUE CROSS
SD6042OtherDAKOTACARE
MN047908000Medicaid
NE46022474342Medicaid
MN92411422911OtherPRIMEWEST
SD4993050OtherBLUE CROSS