Provider Demographics
NPI:1235670746
Name:MCQUEEN, STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:600 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0589
Mailing Address - Country:US
Mailing Address - Phone:304-598-4478
Mailing Address - Fax:304-599-0796
Practice Address - Street 1:600 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:STE 210
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0589
Practice Address - Country:US
Practice Address - Phone:304-598-4478
Practice Address - Fax:304-599-0796
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant