Provider Demographics
NPI:1609864669
Name:MA, STEVEN JEBUM (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JEBUM
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-0845
Mailing Address - Country:US
Mailing Address - Phone:540-377-4488
Mailing Address - Fax:
Practice Address - Street 1:605 EMANCIPATION HWY STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8403
Practice Address - Country:US
Practice Address - Phone:540-368-2011
Practice Address - Fax:540-368-0326
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012333607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24740Medicare UPIN
00W031P01Medicare PIN