Provider Demographics
NPI:1215909007
Name:PINKERTON, STEPHEN JAMES (PA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 24TH ST
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-9159
Mailing Address - Fax:877-874-1008
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9159
Practice Address - Fax:877-874-1008
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004591-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant