Provider Demographics
NPI:1548282916
Name:COLAVITO, STEFANIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ANN
Last Name:COLAVITO
Suffix:
Gender:F
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:
Practice Address - Street 1:1141 HOSPITAL DR NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2164
Practice Address - Country:US
Practice Address - Phone:812-738-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97124207R00000X
NJ25MA07782300207R00000X
KY49502207R00000X
IN01082601A208M00000X
ORMD217114208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91797OtherBCBS
FL276876300Medicaid
FL91797OtherBCBS
FLI24849Medicare UPIN
FLP00466184Medicare PIN