Healthcare Provider Details

I. General information

NPI: 1720080104
Provider Name (Legal Business Name): VICTORIA M. STOEPPLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CLYBURN PL
AIKEN SC
29801-4193
US

IV. Provider business mailing address

139 BARNARD AVE SE
AIKEN SC
29801-7203
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-0578
  • Fax: 803-649-2788
Mailing address:
  • Phone: 803-649-4245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10152
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: