Individual
DR. STEPHEN MICHAEL BANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2280 OPITZ BLVD, SUITE 340, WOODBRIDGE, VA 22191-3362
(703) 878-0777
(703) 583-1777
Mailing address
207 JEFFERSON ST, ALEXANDRIA, VA 22314-4323
(703) 878-0777
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101055871
VA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
0101055871
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6500226
—
VA
Enumeration date
01/03/2006
Last updated
03/12/2019
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