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Individual

STEPHAN J VIVIAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 J CLYDE MORRIS BLVD FL ANNEX1, NEWPORT NEWS, VA 23601-1929
(757) 594-2074
(757) 594-3369
Mailing address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-2297
(260) 434-6116

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01081770A
IN
207RC0000X
Cardiovascular Disease Physician
35059262V
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
0101242715
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1619975877
VA
01
P00445778
MEDICARE RAILROAD
VA
Enumeration date
07/12/2005
Last updated
02/07/2022
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