Provider Demographics
NPI:1073592903
Name:BISSETTE, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:BISSETTE
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 LOWES FOODS DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-8258
Practice Address - Country:US
Practice Address - Phone:336-893-2270
Practice Address - Fax:336-893-2279
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009601231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911055Medicaid
NC8911055Medicaid
NC2245229AMedicare ID - Type Unspecified