Provider Demographics
NPI:1972565265
Name:STIEFEL, BRIAN HARRIS (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HARRIS
Last Name:STIEFEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TERRACE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4392
Mailing Address - Country:US
Mailing Address - Phone:276-783-7167
Mailing Address - Fax:276-783-6432
Practice Address - Street 1:1020 TERRACE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4392
Practice Address - Country:US
Practice Address - Phone:276-783-7167
Practice Address - Fax:276-783-6432
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA288271OtherANTHEM
VA436240OtherSOUTHERN HEALTH
VA0005641551Medicaid
H29800Medicare UPIN