Provider Demographics
NPI:1013216282
Name:ABBOTT, STEPHEN TYLER (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TYLER
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LEIGH FARM RD APT 401
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-8127
Mailing Address - Country:US
Mailing Address - Phone:401-480-4859
Mailing Address - Fax:919-774-2132
Practice Address - Street 1:1135 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-774-2350
Practice Address - Fax:919-774-2132
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01108208100000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist