Healthcare Provider Details

I. General information

NPI: 1821403247
Provider Name (Legal Business Name): STEPHEN LEGRANDE VANCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY STE 310
CHARLOTTESVILLE VA
22911-8836
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY STE 310
CHARLOTTESVILLE VA
22911-8836
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-0027
  • Fax: 434-923-3376
Mailing address:
  • Phone: 434-977-0027
  • Fax: 434-923-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2019-00658
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number021502
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: