Provider Demographics
NPI:1174516835
Name:STOVER, ANNE MCPHERREN (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MCPHERREN
Last Name:STOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 DEBARTOLO PL
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7004
Mailing Address - Country:US
Mailing Address - Phone:330-726-9355
Mailing Address - Fax:330-726-9444
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:SUITE 1650
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-726-9355
Practice Address - Fax:330-726-9444
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9666-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0965568Medicaid
ST4106702Medicare PIN