Individual
ILENE FORREST STEPHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12420 WARWICK BLVD, BUILDING 3, SUITE 4A, NEWPORT NEWS, VA 23606
(757) 594-4431
(757) 594-2936
Mailing address
856 J. CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1318
(757) 594-4006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101226300
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235253246
—
VA
Enumeration date
03/16/2007
Last updated
10/06/2011
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