Healthcare Provider Details

I. General information

NPI: 1033798772
Provider Name (Legal Business Name): STEPHANIE GAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 20TH STREET SUITE 205
HUNTINGTON WV
25703-2071
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1500
  • Fax: 304-691-1510
Mailing address:
  • Phone: 304-691-1500
  • Fax: 304-523-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number57.251056
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34513
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: