Provider Demographics
NPI:1952563728
Name:STUHLDREHER, JACQUELENN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELENN
Middle Name:MARIE
Last Name:STUHLDREHER
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 1:3000 COLISEUM DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-7250
Mailing Address - Fax:757-224-2198
Practice Address - Street 1:3000 COLISEUM DR STE 100
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-7250
Practice Address - Fax:757-224-2198
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351212462086S0129X
OH35.1212462086S0129X
VA01012662052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384878Medicaid