Healthcare Provider Details

I. General information

NPI: 1275236572
Provider Name (Legal Business Name): STEPHEN PAUL BAKELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HEALTH CARE DR
PENNINGTON GAP VA
24277-2853
US

IV. Provider business mailing address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 423-925-1790
  • Fax:
Mailing address:
  • Phone: 423-925-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101290167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: