MEDICARE: DR. STEPHEN SANDER FROST MD

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	207RG0100X	Gastroenterology Physician	014263	ME

General Provider Information

NPI Number	:	1730180068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN SANDER FROST MD

Provider Business Mailing Address
First Line	:	411 N FAIRFAX ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2321
Country	:	US
Telephone Number	:	202-297-3330
Fax Number	:	202-762-1626

Provider Business Practice Location Address
First Line	:	411 N FAIRFAX ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2321
Country	:	US
Telephone Number	:	202-297-3330
Fax Number	:	202-762-1626

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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