Healthcare Provider Details

I. General information

NPI: 1063654879
Provider Name (Legal Business Name): STEPHANIE LAREAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7000
  • Fax: 540-985-6920
Mailing address:
  • Phone: 540-981-7000
  • Fax: 540-985-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101253357
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: