Provider Demographics
NPI:1073611091
Name:NORTH, STEPHEN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:NORTH
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 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:11728 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8954
Practice Address - Country:US
Practice Address - Phone:828-765-5672
Practice Address - Fax:828-765-5676
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00475207QA0000X, 207Q00000X
LA326033207QA0401X
MA286296207QA0401X
NY223824207QA0401X
OH35.140995207QA0401X
TXT9199207QA0401X
WAMD61123191207QA0401X
NC206-00475207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8907673OtherMEDCAID PHYSICIAN
NC235013OtherMEDICARE PHYSICIAN
NC014MXOtherBCBS LABS
NC07673OtherBCBS PHYSICIAN
NC34U011OtherMEDICARE SWINGBED
NC235013BOtherMEDICARE PHYSICIAN
NC00513OtherBCBS
NC3400011OtherMEDCAID
NC411013849OtherMEDICARE RAILROAD
NC0081POtherBCBS SWINGBED
NC34U011OtherMEDICARE SWINGBED
NC340011Medicare Oscar/Certification