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General NPI Number Information
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NPI Number | 1134195159
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Entity Type | Individual
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Provider Name | STEPHEN C MEDLIN DO
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 8081 INNOVATION PARK DR FL 4
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City | FAIRFAX
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State | VA
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Zip | 22031-4867
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Country | US
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Telephone | 571-472-1390
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Fax | 571-472-1391
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Provider Business Mailing Address
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Address Line | PO BOX 37174
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City | BALTIMORE
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State | MD
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Zip | 21297-3174
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Country | US
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Telephone | 571-423-5699
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Fax | 571-423-5698
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 6042
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 44942
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 34.010546
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 0102207694
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License Number State | VA
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