=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356497630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY MICHAEL STEFANIK D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 04/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7915 LAKE MANASSAS DR STE 305
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20155-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-830-1500
-----------------------------------------------------
Fax | 703-830-0001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 861576
-----------------------------------------------------
City | VINT HILL FARMS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20187-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-830-1500
-----------------------------------------------------
Fax | 703-830-0001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0102036992
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------