Provider Demographics
NPI:1962517847
Name:STEVENS, JOEL (MD PC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2993
Mailing Address - Country:US
Mailing Address - Phone:202-462-6479
Mailing Address - Fax:202-723-3106
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 204
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2993
Practice Address - Country:US
Practice Address - Phone:202-462-6479
Practice Address - Fax:202-723-3106
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD6819208600000X
MDD0023042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0569OtherBXBS
160132Medicare PIN
C88028Medicare UPIN