Provider Demographics
NPI:1356325161
Name:LOSTETTER, STEPHEN JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:LOSTETTER
Suffix:JR
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 1:620 SUMMIT CROSSING PL
Mailing Address - Street 2:STE 106
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2176
Mailing Address - Country:US
Mailing Address - Phone:704-867-8021
Mailing Address - Fax:704-864-4606
Practice Address - Street 1:620 SUMMIT CROSSING PL
Practice Address - Street 2:STE 106
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2176
Practice Address - Country:US
Practice Address - Phone:704-867-8021
Practice Address - Fax:704-864-4606
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000 008792085B0100X
NC2000008792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
126PMOtherBLUE CROSS BLUE SHIELD
98499OtherMEDCOST
2353103OtherAETNA HMO
NC89126PMMedicaid
SCN00870Medicaid
16 46194OtherUNITED HEALTH CARE
36110OtherPARTNERS
7360177OtherAETNA PPO
300110412OtherRAILROAD MEDICARE
98499OtherMEDCOST
7360177OtherAETNA PPO