Healthcare Provider Details

I. General information

NPI: 1164476263
Provider Name (Legal Business Name): SUSAN ELLEN STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 AUBURN RD STE 2
CONCORD TWP OH
44077-9621
US

IV. Provider business mailing address

8007 AUBURN RD STE 2
CONCORD TWP OH
44077-9621
US

V. Phone/Fax

Practice location:
  • Phone: 440-296-5915
  • Fax: 440-709-8403
Mailing address:
  • Phone: 440-296-5915
  • Fax: 440-709-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number35056000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: