Provider Demographics
NPI:1447489174
Name:NG, STEPHANIE B (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:NG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7214 TANAGER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3533
Mailing Address - Country:US
Mailing Address - Phone:973-828-5731
Mailing Address - Fax:
Practice Address - Street 1:2201 CHARLES ST STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3378
Practice Address - Country:US
Practice Address - Phone:703-585-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0082340207R00000X
DCDO034787207R00000X
VA0102204276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine