1225354426 NPI number — STEPHANIE L PEGLOW DO

Table of content: STEPHANIE L PEGLOW DO (NPI 1225354426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225354426 NPI number — STEPHANIE L PEGLOW DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEGLOW
Provider First Name:
STEPHANIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225354426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 EMANCIPATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23667-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-722-9961
Provider Business Mailing Address Fax Number:
757-722-9961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 EMANCIPATION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23667-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-622-9961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0802X , with the licence number:  0102203067 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 0102203067 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1225354426 . This is a "ANTHEM BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225354426 . This is a "MAGELLAN HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1225354426 . This is a "VIRGINIA PREMIER HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225354426 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225354426 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225354426 . This is a "SEDGWICK CMS" identifier . This identifiers is of the category "OTHER".




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