Healthcare Provider Details

I. General information

NPI: 1871156679
Provider Name (Legal Business Name): STEPHANIE WAGSTAFF LAFAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 11TH ST
FRONT ROYAL VA
22630-3512
US

IV. Provider business mailing address

186 N CHARLES ST.
STRASBURG VA
22657
US

V. Phone/Fax

Practice location:
  • Phone: 540-631-3700
  • Fax:
Mailing address:
  • Phone: 828-230-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101270785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: