Healthcare Provider Details

I. General information

NPI: 1548282916
Provider Name (Legal Business Name): STEFANIE ANN COLAVITO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 HOSPITAL DR NW
CORYDON IN
47112-2164
US

IV. Provider business mailing address

PO BOX 38
CORYDON IN
47112-0038
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4251
  • Fax:
Mailing address:
  • Phone: 812-738-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD217114
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC196221
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME97124
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61556124
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49502
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD61556124
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07782300
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01082601A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: