Healthcare Provider Details

I. General information

NPI: 1629336821
Provider Name (Legal Business Name): STEPHEN NEABORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 WISCONSIN AVE NW SUITE 401
WASHINGTON DC
20016-4119
US

IV. Provider business mailing address

5100 WISCONSIN AVE NW SUITE 401
WASHINGTON DC
20016-4119
US

V. Phone/Fax

Practice location:
  • Phone: 202-527-7500
  • Fax: 202-527-7400
Mailing address:
  • Phone: 202-527-7500
  • Fax: 202-527-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD043097
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: