Healthcare Provider Details

I. General information

NPI: 1730180068
Provider Name (Legal Business Name): STEPHEN SANDER FROST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N FAIRFAX ST
ALEXANDRIA VA
22314-2321
US

IV. Provider business mailing address

411 N FAIRFAX ST
ALEXANDRIA VA
22314-2321
US

V. Phone/Fax

Practice location:
  • Phone: 202-297-3330
  • Fax: 202-762-1626
Mailing address:
  • Phone: 202-297-3330
  • Fax: 202-762-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number014263
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: