Healthcare Provider Details

I. General information

NPI: 1962859637
Provider Name (Legal Business Name): STEPHANIE D. BAJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR FL 6
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2718
  • Fax: 434-243-6546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005214
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: