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NPI Code Detail

MEDICARE: ERICA ILENA STEVENS M.D.

MEDICARE: ERICA ILENA STEVENS 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
1207N00000XDermatology Physician4301102430MI
2207N00000XDermatology Physician0101287395VA
3390200000XStudent in an Organized Health Care Education/Training Program
4207N00000XDermatology PhysicianS0384TX

General Provider Information

NPI Number : 1174882526
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA ILENA STEVENS M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 3300 GALLOWS RD
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22042-3307
Country : US
Telephone Number : 703-776-3582
Fax Number : 571-665-6492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2012
Last Update Date : 02/24/2026

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