Provider Demographics
NPI:1124051677
Name:SOOFER, STEPHANIE B (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:SOOFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7308
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0308
Mailing Address - Country:US
Mailing Address - Phone:800-292-1387
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:502-456-7075
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222257207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC028799100Medicaid
16699OtherGEORGE WASHINGTON UNIV
DC1022-0005OtherCAREFIRST BLUE CROSS BS
1305167OtherUNITED MINE WORKERS
506848OtherNATIONAL CAPITAL PPO
VA006604811Medicaid
SCQ22257Medicaid
220028329OtherRAILROAD MEDICARE
VA451401OtherANTHEM BLUE CROSS BS
VA490050CG71296OtherSECTION 1011 MEDICARE
279438OtherMDIPA
11-00277OtherUNITED HEALTHCARE
279438OtherOPTIMUM CHOICE
NY94046OtherBLUE CROSS BLUE SHIELD
DC96-246-5316OtherWORKERS COMP DC
279438OtherMAMSI
VA490050CG71296OtherSECTION 1011 MEDICARE
VA451401OtherANTHEM BLUE CROSS BS