MEDICARE: DR. STACY ANN-MARIE DEHAL M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101057518	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922009265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY ANN-MARIE DEHAL M. D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7680
Fax Number	:	704-316-7106

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR
Second Line	:	SUITE 205
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3258
Country	:	US
Telephone Number	:	571-261-3529
Fax Number	:	703-753-5613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/25/2020

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