Provider Demographics
NPI:1720080104
Name:STOEPPLER, VICTORIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:STOEPPLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BARNARD AVE SE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-7203
Mailing Address - Country:US
Mailing Address - Phone:803-649-4245
Mailing Address - Fax:
Practice Address - Street 1:1000 CLYBURN PL
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4193
Practice Address - Country:US
Practice Address - Phone:803-649-0578
Practice Address - Fax:803-649-2788
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC101525Medicaid
SCB91542Medicare UPIN