Provider Demographics
NPI:1184621344
Name:ROSENFELD, STEPHEN P (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:ROSENFELD
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 1:2901 TELESTAR CT.
Mailing Address - Street 2:#300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:4825 MARK CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1846
Practice Address - Country:US
Practice Address - Phone:703-751-8111
Practice Address - Fax:703-751-1105
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033091207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184621344Medicaid
MD762551100Medicaid
DC031727100Medicaid
VA060062624OtherRAILROAD MEDICARE VA#
DC060035105OtherRAILROAD MEDICARE DC #
DC027840C42Medicare PIN
VA022535T55Medicare PIN
MD762551100Medicaid