MEDICARE: DR. STACEY L EPPS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	0101058954	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09633	OTHER	VA	GROUP PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154391571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY L EPPS M.D.

Provider Business Mailing Address
First Line	:	11601 IRON BRIDGE RD
Second Line	:	SUITE 207
City	:	CHESTER
State	:	VA
Zip	:	23831-1466
Country	:	US
Telephone Number	:	804-285-6880
Fax Number	:	804-706-1585

Provider Business Practice Location Address
First Line	:	11601 IRON BRIDGE RD
Second Line	:	SUITE 207
City	:	CHESTER
State	:	VA
Zip	:	23831-1466
Country	:	US
Telephone Number	:	804-285-6880
Fax Number	:	804-706-1585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	06/02/2010

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