Provider Demographics
NPI:1750378618
Name:CLEMENT, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2369 STAPLES MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:804-285-4465
Mailing Address - Fax:804-285-8382
Practice Address - Street 1:201 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-285-8206
Practice Address - Fax:804-320-3102
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029505207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006089186Medicaid
110006183Medicare PIN
VA006089186Medicaid